Golfer Leaves Hospital as a Survivor, Returns as a Winner

Scott A. Miller/Associated Press

After her first pro golf victory in May, Laura Kueny visited the children's hospital that treated her for leukemia 20 years ago.

GRAND RAPIDS, MICH. — It had been nearly 20 years since the golfer Laura Kueny walked through the doors of Helen DeVos Children's Hospital as a young leukemia patient, but that same deep tug of anxiety came rushing back during a recent visit.

Kueny, 25, had returned for an important reason.

She had won her first tournament as a professional on the Symetra Tour, the L.P.G.A.'s feeder system, and took her trophy to the hospital to show Colleen Gardner, a registered nurse who was there when Kueny had experienced chemotherapy, high fevers and spinal taps as a 4-year-old.

"As I sat in that waiting room, I still felt the same nerves I had when I was little," said Kueny, a third-year pro who grew up in Whitehall, Mich. "It was bittersweet, and it almost brought tears to my eyes."

Those feelings were magnified when Kueny was among current patients and their parents in the hospital's waiting area. Kueny gave the nurse a signed photograph of her holding the trophy with the words "Never Give Up" written on the photo. She asked Gardner to post the photograph and if the children asked, she could tell them Kueny was a former patient now following her dreams.

"They were staring at me, and it was an overwhelming moment I can't describe," said Kueny, who often visits children in cancer centers during tour stops. "I didn't always have hope when I was little, but I want these kids to have it."

Kueny was 3 in 1992 when she was found to have acute lymphocytic leukemia, a cancer of the blood and bone marrow. The news came as a shock to her parents, Jim and Karen Kueny, who were 23 and 22 at the time.

"They called our priest, and he showed up," said Jim Kueny, a golf club pro in Michigan. "It was all like a dream."

When the treatments began for her leukemia, Kueny was required to lie on a table in a fetal position while a long needle was inserted into her spinal cord. Multiple times, nurses held her down as doctors tested her bone marrow.

"I actually have a scar on my lower back from the spinal taps," Kueny said.

Kueny went through two and a half years of chemotherapy, lost her hair and became bloated from a drug, prednisone, used in her treatments. Her older sister Nicole came to her defense whenever she was teased.

The worst memory of her leukemia treatment involved a bronchial inhalation procedure in which Kueny was placed alone in a small, enclosed chamber. Antibiotics were sprayed into the chamber while Kueny inhaled the vapors.

"I remember crying and banging on the door and screaming for my parents to let me out," Kueny said. "That's when I learned to swallow pills instead of going through that."

Fortunately for Kueny, she was too young to understand how ill she was. She certainly did not understand why she was poked and prodded so often at the hospital.

"I knew there was something different about me, but I had no idea what was going on," she added.

Her mother, a registered nurse, understood the medical aspects of the disease and was encouraged by the fact that, statistically, her daughter's age and gender gave her an 80 percent chance of being cured.

"We tried to be stoic so Laura wouldn't be scared," Karen Kueny said. "I cried a lot in the shower."

Kueny's initial hospital stay was seven days. Doctors said she had gone into remission within two weeks. But when her fever spiked again, Kueny returned to the hospital for more treatment.

"Some kids there relapsed and didn't make it," Karen Kueny said. "It was really scary, and it's so sad that we knew children who did not have the success that Laura had."

Kueny picked up a golf club for the first time at age 4 during a charity golf outing to raise money for her medical expenses. The event was at Lincoln Golf Club in Muskegon, Mich., where her father was the club pro.

Kueny was weak from chemotherapy at that event, but she swung a cutdown club a few times on the first tee.

13.57 | 0 komentar | Read More

Data Points: Why a Health Insurance Penalty May Look Tempting

OFTEN, when the government wants you to do something, it makes you pay if you don't. That would seem to be the case with Obamacare, which penalizes companies for not providing health care. But in that penalty, there could be a paradoxical result: dropping health coverage could save companies a lot of money.

Once new health insurance exchanges are up and running in October, companies with 50 or more full-time employees will face a choice: Provide affordable care to all full-time employees, or pay a penalty. But that penalty is only $2,000 a person, excluding the first 30 employees. With an employer's contribution to family health coverage now averaging $11,429 a year, taking that penalty would seem to yield big savings.

Yet there may be costs in employee satisfaction, especially if companies don't raise pay enough to keep workers whole when they buy insurance on the exchanges.

"No one wants to drop health insurance and have unhappy employees," says Rick Wald, who heads Deloitte's employer health care consulting practice.

Few experts see immediate, big changes to existing employer-sponsored coverage. But that may change in time. A generation ago, defined-benefit  pensions were prevalent. Not so today.

So why did the government set the penalty at $2,000?

Policy experts don't agree on the rationale, and the White House didn't respond to requests for comment. Perhaps the intent was to start a gradual shift from employer-sponsored coverage to the new exchanges. Or maybe the low amount was a compromise needed to pass the law.

Whatever the reason, the government is about to conduct a huge experiment in corporate decision-making.

Sources: 2012 Employer Health Benefits survey from the Kaiser Family Foundation and Health Research and Educational Trust; the Affordable Care Act

13.57 | 0 komentar | Read More

News Analysis: Profiting From Pain

THE use of narcotic painkillers, or opioids, has boomed over the past decade as drug makers and doctors have promoted them for a new use: treating long-term pain from back injuries, headaches, arthritis and conditions like fibromyalgia. Insurers have also grown to see pills as a cheaper way to treat chronic pain than other methods.

Some patients are greatly helped by opioids, a large family of medications. Among the more widely used opioids are oxycodone, which is found in Percocet and OxyContin, and hydrocodone, which is used in Vicodin. Other potent opioids include fentanyl and methadone. Narcotic painkillers are now the most widely prescribed class of medications in the United States, and prescriptions for the strongest opioids, including OxyContin, have increased nearly fourfold over the past decade.

There is increasing evidence, however, that such drugs, along with being widely abused, are often ineffective in treating long-term pain and can have serious consequences, particularly when used in high doses. Along with the risk of addiction, side effects can include psychological dependence, reduced drive, extreme lethargy and sleep apnea.

The economic costs associated with the painkiller boom have also proved enormous, giving rise to a host of unanticipated medical, legal and social costs. Over the past decade, the legal — and illegal — use of these drugs has given birth to new businesses and expanded existing ones. These include urine-screening tests to make sure patients are taking the drugs properly, added sales of addiction treatment drugs, growing emergency-room expenses, law-enforcement budgets and skyrocketing costs for insurers.

In the short run, treating a patient with an opioid like OxyContin, which costs about $6,000 a year, is less expensive than putting a patient through a pain-treatment program that emphasizes physical therapy and behavior modification. But over time, such programs, which run from $15,000 to $25,000, might yield far lower costs.

Here is a brief guide to the economics of opioids.

Barry Meier is a reporter who covers business and medicine for The New York Times and the author of the Times e-book "A World of Hurt: Fixing Pain Medicine's Biggest Mistake."

13.57 | 0 komentar | Read More

A Louisville Clinic Races to Adapt to the Health Care Overhaul

By Emma Cott

A Clinic Braces for Change: Patients and caregivers at Family Health Centers in Louisville, Ky., wonder how the Affordable Care Act will affect them. Part I in a series about the new health care law in action.

LOUISVILLE, Ky. — One morning last month, a health clinic next to a scruffy strip mall here had an unlikely visitor: a man in a suit and tie, seeking to bring a dose of M.B.A. order to the operation.

Articles in this series will examine how the Obama health care law is affecting lives in one American city.

A dozen clinic employees, who spend intense, chaotic days treating an unending stream of Louisville's poor and uninsured, stared stonily at handouts he had brought as he made his pitch.

The visitor was Danny DuBosque, a "coach" hired to help the nonprofit clinic adapt to the demands of the federal health care overhaul. He had come to discuss a new appointment system, one that will let patients see a doctor or nurse within a few days of calling, instead of weeks or months.

"It's a huge satisfier," he declared — management-speak that fell flat with Dr. Michelle Elisburg, a pediatrician who was scheduled to see 26 patients that day.

"It puts me on edge," said Dr. Elisburg, who has spent her career treating the poor. "Under this model, it's first come first served, whoever calls fastest. But that's not necessarily the patient who really needs to be seen."

Mr. DuBosque, 35, raised his arms, a plea for patience. "We're going to take the next few years going through and untangling all these issues," he said before hurrying to another meeting.

"It's frightening," Dr. Elisburg, 42, murmured as Mr. DuBosque left.

The debate that morning was just one expression of the tensions rippling through medical offices around the country in the countdown to January, when the Affordable Care Act will require most Americans to have health insurance or pay a tax penalty. For doctors and their staffs, this is a period of fevered preparation for the far-reaching changes that are soon to come as the law moves out of the realm of political jousting and into the real world.

To follow how the historic law is playing out, The New York Times will look periodically at its impact in Louisville, a city of 600,000 that embodies both the triumphs and the shortcomings of the medical system in the United States.

The nation's first hand transplant was performed here, as was the world's first implant of a self-contained artificial heart. One of the nation's largest insurers, Humana, is based here, and the city's downtown area alone has four hospitals and a medical school. Health care increasingly fuels the local economy, accounting for many of the largest employers and a growing number of start-ups.

Yet for all the resources and expertise, the health outcomes in Kentucky remain "horrendous," as Gov. Steven L. Beshear, a Democrat, put it recently. The state has some of the nation's highest rates of smoking, obesity and deaths due to cancer and diabetes. At this point, the only sure thing about putting the law's many pieces in place here is that it will not be easy.

The potential benefits are huge. Some 90,000 people could get medical coverage in this city alone. It could create thousands of jobs in Kentucky and, if its aspirations are realized, provide better care at lower cost. Yet the law still provokes suspicion and confusion, among both health care providers and the uninsured population it is meant to help.

Community clinics like the one Mr. DuBosque was visiting, one of seven in a network here called Family Health Centers, are at the front lines of the change. They expect that their patient load could double, even as they struggle to recruit doctors and other staff members. They serve people who, because of poverty or entrenched habits, often have a hard time staying healthy and tend to put off preventive care. Now these clinics are anticipating competition from private providers who may see newly insured patients — no matter how poor — as opportunities for profit. So they are working on improving the patient experience and their own efficiency.

The legislation allots $11 billion over five years to improve and expand community clinics across the nation. Family Health Centers is getting $5.4 million to renovate a clinic for the homeless and move a downtown clinic to a much bigger building, adding dental and X-ray departments and a pharmacy. The organization hopes to eventually serve 10,000 additional patients at that site alone, if it can hire enough doctors and nurses to treat them. Meanwhile, it is using federal stimulus money to convert 60,000 paper charts to electronic medical records, and trying to improve patient access with the new scheduling system and other changes.

"We have to change from being the provider of last resort to the first choice for the community we serve," said Bill Wagner, the longtime executive director of Family Health Centers. "Everything we do needs to say, 'You're valuable to us.' "

Soft of voice and low-key, Mr. Wagner, 60, nonetheless acknowledges that the stakes for Family Health Centers are unnervingly high. He gets to work at 6:30 a.m. these days, relies on a steady stream of caffeine and clears his head with weekend motorcycle rides.

"We couldn't have more balls in the air right now," he said.

Patients and Problems

13.57 | 0 komentar | Read More

U.S. Moves to Seize Dietary Supplement From GNC Warehouses

Federal prosecutors have asked judges in two states to authorize the seizure of more than 3,200 cases of controversial workout products from warehouses operated by GNC, the nation's largest specialty retailer of dietary supplements.

With names like Jack3d and OxyElitePro, the workout products contain a stimulant called dimethylamylamine, or DMAA for short. In April, the Food and Drug Administration warned consumers that DMAA was an illegal dietary ingredient and that products containing the stimulant could elevate blood pressure, potentially leading to heart attacks.

After the agency's warning, USPlabs, the maker of Jack3d and OxyElite Pro, said the company for business reasons had decided to stop making DMAA products. Some leading retailers withdrew their remaining stocks of DMAA products from store shelves, but GNC continued to sell its inventory.

Greg Miller, a spokesman for GNC, said in an e-mail on Friday that the company believed DMAA to be a "safe, legal dietary ingredient."

But in a challenge to GNC, the Justice Department, acting at the behest of the F.D.A., requested court-ordered seizures this week of both Jack3d and OxyElitePro from GNC warehouses in Leetsdale, Pa., and Anderson, S.C.

According to a complaint filed in Federal District Court in Pittsburgh, the F.D.A. conducted an inspection of the GNC warehouse in Leetsdale this month and collected physical samples, photographed the products and seized shipping records. After the inspection, F.D.A. officials notified GNC that the products were adulterated and being illegally held by the company. On June 11, the F.D.A. ordered GNC to detain the products.

Federal prosecutors filed a similar complaint on Tuesday in Federal District Court in Anderson, S.C., seeking a seizure of the same products at a GNC facility there.

Because the dietary supplement industry tends to voluntarily heed F.D.A. public advisories, the agency rarely feels compelled to take the aggressive tack of seizing products.

Shelly L. Burgess, an F.D.A. spokeswoman, said the agency would not comment.

Mr. Miller, the GNC spokesman, said the company would not distribute the products at its Leetsdale warehouse until the issue with the F.D.A. had been resolved. But, he said, "GNC will continue to sell through its remaining inventory of the products in its stores."

Mr. Miller added that it was unclear to the company why the F.D.A. had initiated the seizure request, given that DMAA-containing products were no longer being made and that distributors other than GNC also had inventories of the products.

"Given this situation," Mr. Miller wrote in his e-mail, "it is hard to view this action as anything other than a biased agency action against GNC in retaliation for GNC's stance on DMAA."

Since early 2008, the F.D.A. has received reports of at least 86 health problems, including at least five deaths, in consumers who used DMAA products. Although such reports do not prove that the stimulant directly caused health problems, agency officials have warned people not to consume the ingredient.

13.57 | 0 komentar | Read More

The New Old Age: A Search for Harmony

Can choral singing really help people age well? Maintain their health and their crucial social connections? Perhaps find their way through grief and loss?

That's a tall order, but the new film "Unfinished Song" quietly makes those claims. Opening in New York and Los Angeles on Friday, and then around the country, it struck me as predictably plotted but with several elements to recommend it:

a) Terence Stamp
b) Vanessa Redgrave
c) Ms. Redgrave, now 75, movingly singing Cyndi Lauper's "True Colors"
d) An energetic choir of other older singers, mostly recruited from actual community choruses in England.

You may recall "Young@Heart," the 2008 documentary about a Northampton, Mass., senior chorus of the same name. Going strong since 1982, the group rehearses twice a week, has released three CDs and has given concerts around the world, most recently in Belgium and Holland.

You might expect performers over age 73 — the minimum age — to stick with memory-fanning songs of their youth. But Young@Heart is currently working on tunes by Yo La Tengo and the Flaming Lips.

"It exercises the brain. You have to learn stuff," the choir director Bob Cilman said. "People work hard to stay in and continue. It's probably good for their health."

There's some evidence that he's right. Choral singing has been shown to strengthen neural connections, fortify the immune system and reduce stress and depression. "It seems to tinker with the chemicals in the brain in just the right way to make people feel better," said Stacy Horn, author of the new book "Imperfect Harmony: Finding Happiness Singing With Others."

As for the impact on older choristers, a 2006 study comparing singers in Washington, D.C., choruses for those over age 65 with nonsinging groups found that the singers reported better health, fewer falls, more activity and less loneliness.

Julene Johnson, a neuroscientist at the University of California, San Francisco, has done similar research in Finland, where choruses for all ages, genders and interests are ubiquitous. When she asked senior singers about their experiences, "they said they got emotional benefits, relaxation and social support" from participating, Dr. Johnson said. "It seemed to have a relationship with how highly they rated their quality of life."

Wouldn't you think there would be scores of similar organizations around the United States for older singers? Possibly there are, but without a national umbrella group, they are hard to track. (Of course, many thousands of older adults probably continue singing with all-age community and church choirs, but I can also see good reasons to form choruses specifically for older adults.)

The Encore Creativity for Older Adults program, which grew out of that 2006 study, now offers 13 choruses for the 55-plus crowd at senior centers and residences and community colleges in Maryland, Virginia and Washington. These seem to favor more traditional vocal music; here's a YouTube video of several Maryland Encore choruses performing Aaron Copland in a concert last month.

In San Francisco, Dr. Johnson is starting the Community of Voices project, recruiting about 400 singers over age 60 — no previous choral experience required — at a dozen senior centers, to study its impact on their mobility, cognition and psychosocial well-being over the course of a year.

A bit north, in Mill Valley, a chorus called Rock the Ages follows the Young@Heart template and recently covered the Who's "My Generation." Of course.

But where else? Let's see if we can come up with a broader list. If you or a family member sings in a chorus for older adults, please tell us about it. Where is your group, and what does it sing? What do you value about the experience?

And a bonus question, suggested by the fact that the chorus in "Unfinished Song" performs not only Billy Joel and Stevie Wonder tunes, but also Salt-N-Pepa's "Let's Talk About Sex." My moviegoing buddy took offense, seeing ageism afoot. Wasn't singing hip-hop and heavy metal a too-cute attempt at pretending to be young? A sacrifice of hard-won dignity? Was the film audience laughing with them, or at them?

I'm ambivalent on the issue. But I can agree with Mr. Cilman of Young@Heart, who says that his chorus members live interesting lives. "They perform for big audiences, they get great responses," he said. "It's unexpected for them. God, I hope something like this happens for me when I'm older."

---

Paula Span is the author of "When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions."

---

This post has been revised to reflect the following correction:

Correction: June 22, 2013

An earlier version of this article misspelled the surname of the composer whose works were performed last month by several Maryland Encore choruses. He was Aaron Copland, not Copeland.

13.57 | 0 komentar | Read More

Business Briefing | Company News: Monsanto Calls Altered Wheat in Field Suspicious

Monsanto officials said that testing of United States wheat had shown that the presence of the company's unapproved, experimental, genetically altered wheat in an Oregon field was highly suspicious and was an isolated incident that could not have happened through normal farming practices. Company officials said more investigation was needed to determine why the wheat, which Monsanto said it stopped field testing in 2005, was found growing in the field in April. Robert T. Fraley, chief technology officer for Monsanto, called the finding in the field suspicious and said evidence indicated that someone had intentionally introduced the modified wheat seed. The testing of soft white wheat was conducted by Washington State University.

13.57 | 0 komentar | Read More

National Briefing | Southwest: Abortion Curbs Advance in Texas

The state took a major step toward enacting new abortion restrictions on Friday after a lawmaker cut short an attempt to stage a "citizen filibuster." Hundreds of people, most of them women opposed to the legislation, were waiting to speak when Representative Byron Cook, the Republican chairman of the State Affairs Committee, said the witnesses had become repetitive and he would allow only two more hours of testimony. Normally each witness may testify for three minutes. Mr. Cook's committee approved all of the measures on a party-line vote without comment. The Republican-backed measures would ban abortions after 20 weeks; the current limit is 24 weeks. They would also require doctors who perform abortions to have admitting privileges at a hospital within 30 miles, and only allow abortions in surgical facilities. Many private hospitals will not grant privileges to a doctor who performs abortions and most abortion clinics do not qualify as ambulatory surgical centers, a standard usually reserved for procedures that involve extensive surgery or general anesthesia. Supporters say the bills would make abortions safer, but abortion-rights groups say they would lead to the shuttering of 37 of the state's 42 abortion clinics.

13.57 | 0 komentar | Read More

World Briefing | Science And Health: One-Third of Women Assaulted by a Partner, Global Report Says

In the first major global review of violence against women, a report released Thursday found that 30 percent of women reported having been physically or sexually assaulted by a former or current partner. The head of the World Health Organization, Dr. Margaret Chan, called it "a global health problem of epidemic proportions," and other experts said screening for domestic violence should be added to all levels of health care. Among the findings: 40 percent of women killed worldwide were slain by a partner. Researchers used a broad definition of domestic violence, and in cases where country data was incomplete, estimates were used to fill in the gaps. The report also examined sexual violence against women by someone other than a partner and found about 7 percent of women had been victims. The report was based on studies from 1983 to 2010.

13.57 | 0 komentar | Read More

Weiner Wants City to Test Single-Payer Health Care

Mr. Weiner, a Democrat who championed a Medicare-for-all style of health care as a congressman, said his plan could curb the rise of $15.5 billion in city spending on health care and save money for raises for teachers and other workers, mainly by using the city's muscle to reduce the profits or the role of private insurance companies.

In return, he proposed that 300,000 city workers and 300,000 retirees who now pay nothing toward their insurance premiums should pay 10 percent — 25 percent if they smoke. An estimated 500,000 undocumented immigrants would also be expected to buy in to the city's insurance coverage, he said, describing it as a more cost-effective way to care for those whose treatment in emergency rooms and city hospitals already falls to taxpayers.

"This isn't about who manages health care; this is about who manages the money in health care," Mr. Weiner said, flicking through slides showing that city spending on workers' health benefits was projected to rise by 40 percent from 2014 to 2017 under the current arrangement. Under an entrenched system partly codified in law, he said, a single private insurance company, Emblem, handles 95 percent of the coverage for the city's workers, and a state board approves annual raises in the rates it charges.

Of insurance companies, he said, "Their job is to take in as much money as they can and pay out as little as they can." The complexity and delays of private insurance processing are no accident, he added: "They make money on the float."

Depending on the recommendations of a government task force he would create under a deputy mayor of health care innovation, he said, city coverage might still be placed in the hands of a different insurance company under a more competitive scheme, or the city might outsource just the administration to an insurer, as Medicare does while keeping overhead as low as 1.3 percent. A third option he listed would be for the city "to take the whole thing in-house."

He said he would reorganize government agencies to seize opportunities presented by the Affordable Care Act, and have his health care innovation task force consider insurance terms that "keep more of the money in the city," like allowing prescriptions to be filled at local pharmacies rather than only by mail order, or using the city's development and investment capability to increase primary care at a hospital facing closure.

"This is not just a conversation you can have around cost," he said, citing the nation's experience in the 1990s with an H.M.O. model that no one liked, and calling the quality of health care in New York "a crown jewel."

The coverage devised by the task force, which he called Thrive (standing for Taskforce for Healthcare Reform, Innovation and Vitality for Everyone), could eventually be offered to all New Yorkers by being listed on the state insurance exchange required by the Affordable Care Act. Such an experiment could not be tried in places like Cincinnati or St. Paul, he went on, but "New York is the health care capital of the world," with more than 560,000 health care workers, including tens of thousands of doctors and nurses in the city's own employ.

A single-payer model has been a hard sell nationally because of concern that it would reduce individual choice and increase government control over health care. Mr. Weiner would also have to win support from the city's unions, which may demand raises high enough to offset any contributions they would be required to make to their premiums.

His talk, at a public lecture series sponsored by the Common Good, a nonprofit, nonpartisan organization, at a City University of New York branch on West 67th Street, stirred enthusiasm and interest. In the hour before he spoke, word of Mr. Weiner's proposal galvanized other Democratic candidates for mayor to issue hurried news releases on health care.

Christine C. Quinn, the City Council speaker, drew attention to the BigAppleRx prescription drug discount card, established by Council legislation, which she said had saved more than 125,000 New Yorkers a total of $15,546,017 on prescription medications, or an overall savings of 47 percent, since May 2011.

Public Advocate Bill de Blasio cited health care positions from his policy book, which includes a pledge to enroll 600,000 uninsured New Yorkers in plans through the Affordable Care Act and to better protect community hospitals.

Mr. Weiner, asked how his health care plan compared with those of his rivals, said he was unfamiliar with theirs, adding with a grin, "And when I say unfamiliar, I may mean I don't think they have any."

13.57 | 0 komentar | Read More