Four Charts On How Health Care Has Changed Since 'Mad Men' - Forbes

“Mad Men” returns for its seventh season on AMC on Sunday night, with Don Draper, Joan Holloway, and the rest of the extended Sterling Cooper family back for an extended final go.

As a health care wonk, one joy of watching “Mad Men” has been how the show’s creators have used the characters’ behaviors—and their interactions with the nation’s health system—to consistently tweak our nostalgic view of the 1960s. (When the show debuted, the plot was set in March 1960; by the time the sixth season wrapped up, “Mad Men” had advanced all the way to November 1968.)

Writing at the Advisory Board Daily Briefing in 2012, I took a deep dive into how health care’s changed since the days of Don Draper, interviewing doctors and nurses who began practicing 50 years ago and highlighting five examples from the show.

The macro-level transformation in health care is also captured in the charts below, which are excerpted from a massive infographic we created for the Daily Briefing. (For the full infographic, click here or scroll to the bottom of this post.)

Here are four of the biggest health care shifts from 1960 to 2014.

1. Health care has become big business.

The show doesn’t focus on one of the most significant changes to the nation’s health care system—the long political battle over Medicare and Medicaid that culminated in 1965—although Season 4 does devote a throwaway line to the debate at the time. ”If they pass Medicare, they won’t stop until they ban personal property,” an older man grumbles at a Christmas party.

That obviously hasn’t happened, although it’s striking to think how public programs have come to dominate the nation’s health spending. More than half of all hospital discharges are from patients covered by Medicare or Medicaid, and that trend is only going to increase—about 10,000 Baby Boomers enroll in Medicare every day, and Obamacare’s Medicaid expansion could further grow that program by more than 21 million in the next decade. By 2030, more than 150 million Americans may be covered by Medicare and Medicaid.

The advent of Medicare also launched a new era: Health care as big business.

Rosemary Gibson of The Hastings Center recently pointed out a striking statistic that sums up the transformation.

• In 1965, there were zero health care companies on the Fortune 100 list.
• In 2013? There were 15.

2. We’re much more mindful of being healthful.

The idea of personal healthfulness is basically non-existent when “Mad Men” opens. Everyone drinks, no one exercises, and even characters who suffer from various medical maladies can’t make the connection between their behaviors and outcomes.

Take Roger Sterling, the suave fellow ad man who’s a mentor to Don. Roger’s a frequent smoker…and in mid-puff when he suffers his second heart attack of Season 1. (“Not again,” he grimaces, cigarette in hand. Although don’t fear for Roger; his character’s back to smoking, drinking, and eating steaks in no time.)

Today, we’re much more conscious of the importance of exercise and a balanced diet, and smoking rates have plummeted among adults. But one surprise: For all of the martinis seen quaffed on the show, we actually drink more today.

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3. Health care itself is much, much better.

This is practically a given, but better prevention, detection, interventions, and management have all contributed to massive improvements in treatment and outcomes. Writing at Forbes, Matthew Herper took a closer look at some of those innovations, like how the catheter revolutionized heart care and the introduction of randomized control trials to better test for medicines that work.

The numbers bear out the transformation. Life expectancy has gone up nearly a full decade since 1960, and if you survive to age 65, you’re expected to live an extra five years. Heart disease remains a serious concern, but a heart attack has gone from a lethal event to a chronic disease that can be managed with medications and other therapies.

And even though the cancer incidence rate has skyrocketed—in part because of improved detection—the mortality rate has plummeted.

4. We’ve come far on gender equality—although we still have a ways to go.

As depicted by the show, the U.S. health care system of the 1960s is openly paternalistic.

Doctor-patient confidentiality apparently doesn’t apply to women: Don Draper regularly gets a rundown of his wife Betty’s therapy sessions—from Betty’s doctor.

And another female character’s manic depression is treated in a barbaric way: She’s forced to undergo electroshock therapy by her husband, ultimately losing some of her memory.

Much of that changed, certainly, as the broad push for equal rights trickled down to medicine. But don’t discount the shifting gender and power roles within health care, as more women became doctors or advanced nurse practitioners. Even nurses’ attire changed in an important way, from skirts in the 1960s to scrubs today.

And yet, gender equality in health care still isn’t fully realized in the year 2014. Male doctors today still are much better compensated than female doctors, partly because of the specialties they choose. And even though female nurses outnumber male nurses by 10 to 1, men still get paid 10% more.

See for yourself how health care’s changed; the full graphic’s below. 

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For the working poor, new health premiums can be a burden - Los Angeles Times

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For nearly two decades, Barbara Garnaus maintained a modest, delicate life balance: keeping her part-time Orange County school district job and juggling her bills and credit card debt.

Now 63, living alone, she counts every dollar, has no cellphone and commutes an hour in traffic so she can keep an affordable apartment in Laguna Woods.

Having good health helped. Garnaus got by without medical insurance, relying on yearly exams at a free clinic. But that changed last year: Garnaus now needs treatment for cancer, and she bought insurance under Obamacare.

Thousands of Californians like Garnaus are poised to reap significant benefits from the nation's healthcare overhaul: access to levels of service and treatment previously out of their reach, and government subsidies that bring down payments dramatically. Still, Garnaus is anxious about taking on even modest additional monthly costs.

At the margins of poverty, even committing to premiums, co-payments and other new medical expenses of hundreds or a few thousand dollars a year can be difficult to manage, according to researchers and groups working with the low-income patients now required by federal law to buy insurance.

"When you talk about paying for something on a monthly basis like that, it's something very real that people have to consider," said Kandis Driscoll, a manager with the Santa Monica-based Insure the Uninsured Project. "It could be a survival decision."

Price was Garnaus' overriding consideration in choosing a policy.

"I got the cheapest one, the very cheapest one," she said. "And for me it's still not cheap."

::

As she reviews invoices at her desk, the tail of a blue scarf wrapped around Garnaus' head brushes her shoulder. Tacked to the wall behind her are photos of her with former colleagues and an old yearbook portrait showing off the wavy blond hair she lost to chemotherapy last year.

She works 20 hours a week ordering pencils and testing materials, earning $22,480 annually before taxes, and isn't eligible for the district's health insurance coverage. She's tried unsuccessfully to get full-time work at the district and elsewhere, she said, but felt it was best to hold on to what she had when the recession hit.

Her monthly take-home paycheck is about $1,750. With her $1,180 rent, about $150 on gasoline and $100 on utilities, she's left with less than $320 each month for food and any other expenses, including medical bills.

In March of last year, Garnaus was diagnosed with a rare but aggressive uterine cancer. She initially received treatment through Orange County's taxpayer-supported healthcare program. She qualified for the low-income program because her earnings fell below the $22,980 annual ceiling the county had set for a single-person household, roughly 200% of the federal poverty level.

When that county program expired Dec. 31, most of the patients transitioned to Medi-Cal, the state's program for the elderly and poor. But Medi-Cal covers people only up to 138% of the poverty level — $15,800 for a single person — which disqualified Garnaus.

Garnaus acknowledges that insurance will be good for her health and finances in the long run but says she's barely able to cover the increased monthly costs. With government subsidies, her monthly insurance premiums are $13.50, and co-pays to see her oncologist are $20. When lab work or a CT scan is required, it can cost up to $100 more.

"I'm continuously getting into debt," she said. Under her plan, she says, she can have up to $2,250 in annual out-of-pocket payments.

During a workday lunch break last month, Garnaus said she was contemplating skipping CT scans recommended by her doctors because of the added cost. "It's a very scary situation," she said.

Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation, a healthcare research group, said that previously uninsured patients living on the cusp of poverty and now required to buy insurance may struggle with the new financial obligations but should focus on the upside.

"These individuals will pay more," she said, "but they will get better benefits."

In February, Garnaus saw her oncologist for the first time with her new insurance. She cringed at the $20 co-payment and $15 for lab tests.

But she was thrilled days later when the results came back. "I'm crystal clear, just clean as a whistle, thank God," she said.

Recently, a friend who also has uterine cancer told Garnaus that a CT scan was the only thing that caught a resurgence of her disease.

Now, Garnaus feels increased pressure to get a scan. She says she's just not sure where she'll get the co-payment.

"That's the $100 I don't have," she said.

soumya.karlamangla@latimes.com

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Chrissy Amphlett's 'I Touch Myself' Reworked for Breast Cancer Campaign: Watch - Billboard

The late Chrissy Amphlett’s iconic song “I Touch Myself” is enjoying an all-star makeover for an Australian breast cancer awareness campaign.

The song, originally a hit in the early '90s for the rocker's band the Divinyls, has been covered by a cast of home-grown stars including breast cancer survivor Olivia Newton-John, ARIA female artist of the year winners Sarah Blasko and Megan Washington, Baby Animals singer Suze DeMarchi, and ARIA Hall of Fame inductee Little Pattie, who is Amphlett’s cousin.

Each of the 10 singers appear in a powerful black and white video which was commissioned by Cancer Council NSW and launched over the weekend. The charity has declared the song as the anthem for its #itouchmyselfproject, which has a dedicated Website at http://itouchmyself.org. 

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The song “celebrates female sexuality like no other,” the charity notes in a statement. “Like Chrissy, it is bold, brave, and brassy. It rocked our world. And when Chrissy developed breast cancer, it was a song she wanted to become an anthem for spreading awareness about the importance of touching ourselves for early detection of the disease.” 

Amphlett died on April 21, 2013 at the age of 53. A mammogram and ultrasound failed to initially detect her cancer. It was only when she self-examined that she returned to the doctor to insist on a biopsy, which in 2010 revealed the cancer. 

Amphlett’s widower Charley Drayton spoke to the Sunday Telegraph ahead of the one-year anniversary of her passing. "She would have wanted us to be more in touch with ourselves and to listen to what's going on inside physically, and to be more in charge of our destiny and not wait for doctors or advisers to be in charge of us,” he said. 

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“I Touch Myself” became an international hit in 1991 when it reached No. 4 on the Billboard Hot 100, No. 10 in the U.K. and No. 1 in Australia, and had radio programmers around the world pondering whether the song was too naughty to spin (Amphlett wrote the work with Mark McEntee, Billy Steinberg and Tom Kelly).

The singers who came together for the new campaign, notes Cancer Council NSW, have done so “to make Chrissy's final wish a reality.”

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Device that prevents hair loss for cancer patients may become available in U.S. - New York Daily News

Bill Denver for New York Daily News Carolyn Dempsey assumed going bald would be part of the physical and psychological assault of chemotherapy, until she found DigniCap.

When the dreaded diagnosis of breast cancer came in May, several thoughts raced through Carolyn Dempsey’s panicked mind.

“First was, ‘Will I live? Will I get to see my children grow up?’ ” recalled the New Jersey music teacher and mother of three. “Next was, ‘Am I going to lose my hair?’ ”

Dempsey, 44, said she assumed losing her signature blond ponytail and going bald would be part of the physical and psychological assault of chemotherapy, along with the nausea and fatigue. But she was prepared to face it all.

Courtesy Dempsey Family

Carolyn Dempsey undergoing chemotherapy for early stage breast cancer at Weill-Cornell Breast Center.

Enlarge Courtesy Dempsey Family

Dempsey is part of the hospital's research trials testing the DigniCap.

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Courtesy Dempsey Family Carolyn Dempsey prior to her fourth and final chemo treatment showing full head of hair.

Bill Denver for New York Daily News Dempsey outside her home in Chatham, N.J.

Until a friend told her about a little-known scalp-cooling technique which has been shown to prevent chemo-induced hair loss for patients with early-stage breast cancer.

Dempsey eventually found her way to the Weill Cornell Breast Center at New York-Presbyterian Hospital, where Dr. Tessa Cigler is heading up a research trial on DigniCap, a Swedish device that has been successfully used in Europe since 1999, but not available in the United States.

That may change in 2015, when New York researchers along with doctors in California and North Carolina, present their promising findings to the FDA.

“Cold-cap therapy is empowering,” said Cigler, the lead researcher for Weill Cornell’s ongoing clinical trial. “It allows women to maintain their self-esteem and sense of well-being, as well as to protect their privacy.

“Without these caps, 100% of the women lose their hair by the second treatment,” she added.

Marta Vallee-Cobham, the clinical research nurse for the trial, said that DigniCap would be a game changer for thousands of American women and men, as it has been overseas.

“For those of us who have been giving chemo for so long, to see that finally there is something to provide confidence to patients is exciting,” said Vallee-Cobham. “When you can offer this, the world changes. You see it in our patients’ whole outlook as they deal with cancer.”

Courtesy Dempsey Family Carolyn Dempsey with husband Brian and staff from DigniCap and Weill-Cornell Breast Center.

Barry Williams for New York Daily News Dr. Tessa Cigler is heading up a research trial on DigniCap.

While sitting in a reclining chair receiving chemo infusion, a snug-fitting silicone cap is fitted onto the patient’s head. The cap is hooked up to a refrigeration unit which cools the scalp to 37 degrees.

The cold constricts the scalp’s blood vessels, which limits the chemo from reaching and killing off hair follicle cells.

“We are very encouraged by the number of patients who have been able to keep their hair,” Cigler said.

Courtesy Dempsey Family Breast cancer survivor Carolyn Dempsey sits with her with her children Calder, 9, (l.) and Austen, 6, (r.), two of her three children, before chemotherapy. Bill Denver For for New York Daily News Breast cancer survivor Carolyn Dempsey (C) says keeping her hair during her treatment helped her family cope with her cancer.  Bill Denver for New York Daily News Carolyn Dempsey, seen with her children and dog, is championing the Swedish technology in the U.S.

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Dempsey said she felt so fortunate to find out about the trial in time. She also worried that being bald would frighten her children — ages 12, 9 and 6.

“Not having that reminder every time you look in the mirror that you are sick, and you look normal to your family made the chemo much more bearable,” said Dempsey, who lost some hair on top of her head. “Instead of illness, I saw myself. Many people had no idea I had cancer.”

She and her husband, Brian, also felt strongly about getting the word out about DigniCap as well as the Penguin cap which has been in use, but much more difficult to use as friends or family have to bring dry ice to the oncology center and change the cap every 30 minutes for a set amount of time — before, during and after chemo.

Barry Williams for New York Daily News The cooling and control unit, DigniC3, of the DigniCap scalp cooling system.

“When Carolyn was diagnosed, we were given Xeroxes with a list of wig makers, but there was no mention of cold caps or DigniCaps,” said Brian Dempsey, a Manhattan graphic designer.

During her final chemo treatment last week at Weill Cornell, breast cancer patient Lauren Desharnais was ecstatic.

As Vallee-Cobham lifted off the cap, Desharnais, who traveled three hours from Albany for her treatments, was amazed when she put her fingers through her scalp.

“It’s startling that my hair is still here!” she said, beaming. She got up from the chair, threw on her trench coat and some pink lipstick, and walked out of the hospital onto the streets of Manhattan. No one would ever know she had been sick.

“It’s no one’s business if you have cancer,” Desharnais said. “This way, you tell who you wish to tell. I’m outraged that in Europe they’ve had this technique for years and not here.”

Barry Williams for New York Daily News Lauren Desharnais has kept most of her hair after receiving scalp-cooling therapy. Barry Williams for New York Daily News Lauren Desharnais, right, receives a hug from clinical research nurse Marta Vallee-Cobham during her last chemotherapy visit at Cornell Weill Breast Center. Barry Williams for New York Daily News Lauren Desharnais, right, shares a laugh with her son Andrew Desharnais after scalp-cooling therapy, which is undergoing clinical trials in New York.  Barry Williams for New York Daily News Lauren and Andrew leave Cornell Weill Breast Center on Tuesday, following her treatment. 

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***

HOW IT WORKS

The DigniCap sits at room temperature when placed snugly on the patient's moistened head 30 minutes before the chemotherapy infusion begins.

The cap, with its internal coils, is hooked up to a refrigeration unit which gradually cools the cap down to 37 degrees. The cooling cap is kept on during the chemo infusion, and then for another 1-2 hours after the infusion.

To minimize any hair loss, patients are advised to put little stress on the hair and scalp, limit washing hair to two times a week, avoid using heat from blow-dryers, curling irons or rollers. Limit brushing or combing hair or coloring hair.

The Weill Cornell Breast Center has an active cold-cap program. For more information, call (212) 821-0644 or go to http://ift.tt/1iJhLLu.

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Blood type influences prostate cancer relapse, study shows - Telegraph.co.uk

A man in consultation following a prostate examination Photo: Alamy

A man's blood group has been shown to significantly influence the chance that prostate cancer will return after successful surgery.

Men with group O blood are far less likely to suffer a recurrence of the disease following surgical intervention.

By contrast, men with blood group A were shown by new research to be 35% more likely to fall victim to the disease again, even after surgery.

Prostate cancer is the most common form of cancer in European men and 40,000 cases are diagnosed in Britain annually.

Study author Dr Yoshio Ohno, of Tokyo Medical University, said: "This is the first time that anyone has shown that prostate cancer recurrence can vary with blood group.

"As yet, we don't know why the risks vary with blood group, but this work may guide us towards new avenues of molecular research on prostate cancer progression.

"Should we be counselling people with certain blood groups that they have a greater or lesser chance of recurrence, and should these risk factors be built into decisions on treatment?"

The new research, presented at the European Association of Urology's (EAU) annual congress in Stockholm this week, tracked 555 patients with prostate cancer between 2004 and 2010.

An individual's blood group is determined by the presence of different antigens and antibodies. Antigens and antibodies serve as the blood's defences against foreign substances.

Group O blood is the most common in the UK with 44% of the population estimated to have the type. Roughly 42% of Britons have group A blood.

Previously, different blood groups have been associated with different risk levels for developing certain cancers, such as gastric and pancreatic cancers.

EAU general secretary Professor Per-Anders Abrahamsson said: "This is an interesting first finding. There is great geographical variation in the incidence of prostate cancer, so there are obviously strong genetic factors at play.

"Blood groups have already been shown to be associated with prostate cancer incidence, now it looks like they might be associated with treatment outcomes as well."

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Odd-Hour Workers Face Loss of Employer Health Plans - Wall Street Journal

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Wall Street Journal

Odd-Hour Workers Face Loss of Employer Health Plans Wall Street Journal Susan Caspersen was in a hospital in Akron, Ohio, last November recovering from an emergency appendectomy when she got some unwelcome news: as of Jan. 1, 2014, she would no longer be eligible for the health-insurance plan offered by her employer, ... and more »

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In New York, Hard Choices on Health Exchange Spell Success - New York Times

In contrast with the early stumbles in most of the country, New York State, almost from the start, has provided a textbook lesson in how to make the Affordable Care Act work. But it has done so by making some tough decisions.

New York has signed up more than 900,000 people for commercial or government plans, lured 16 insurance companies onto its exchange, provided subsidies for most customers and reduced premiums across the board.

“I have to say that on the whole this is a very savvy bunch of people they have operating the exchange,” Mark P. Scherzer, a lawyer and consumer advocate , said. “It really is a story of something that government could actually do right.”

The state’s success was no accident. It began with a receptive customer base and the benefit of experience, since New York already had some of the country’s most generous insurance coverage for the poor and sick. Resistance to the health exchange among Republicans in the state may, oddly enough, have helped make it more successful.

But New York also took some aggressive and unpopular steps that few other states have taken, by creating a highly centralized system limiting consumer choice, essentially giving insurance seekers little incentive to shop off the exchange.

As a result, most New Yorkers who are not insured through an employer are effectively barred from choosing any doctors or hospitals they want.

At least 100,000 people have lost their old health plans because they did not conform to new federal requirements. Thousands more freelancers and other “sole proprietors” were barred from banding together for group insurance rates, a change in longstanding practice that almost certainly pushed more consumers to buy insurance on the exchange.

Donna Frescatore, executive director of New York State of Health, as the exchange is called, said the state’s decisions had been vindicated by the fact that premium rates had dropped more than 50 percent from previous years.

Individual premiums for Manhattan residents, for instance, dropped from $1,534 for a standard health maintenance organization, or H.M.O., in 2013 to $621 for a comparable exchange plan now. “I think it has in part ensured that customers have affordable options,” Ms. Frescatore said.

Long before President Obama was elected, New York was a pioneer in requiring insurance companies to provide individual or small-group coverage to people regardless of existing illness, and to price it without regard to health, age, gender or occupation, core provisions of the Affordable Care Act.

And while the federal law allows children to be covered under their parents’ policies until they turn 26, New York already required offering coverage up to 30, and still does.

“So in those other states, you have health plans trying to figure it out,” said Peter Newell, an analyst for the United Hospital Fund, a nonprofit research organization. “In New York, you could sidestep a lot of problems.”

Still, the exchange had a rough start. Republicans in the State Senate tried to block it by refusing to support the creation of an independent authority to run it. New York could have followed 36 other states in simply joining the exchange set up by the federal government, whose numerous problems were not yet evident. Instead Gov. Andrew M. Cuomo established the state ’s exchange by executive order, deeding it to “seasoned stagehands,” as Mr. Newell put it, in the Health Department.

About 508,000 of those who enrolled qualified for Medicaid and 63,000 for Child Health Plus, another government-subsidized plan; 363,000 bought private plans. The number who purchased private plans by March 31, the enrollment deadline for 2014 coverage, exceeded federal government predictions for New York by more than 60 percent. Nationwide, thanks to a last-minute surge, 7.1 million people signed up for private plans by the end of March, allowing the Obama administration to hit its goal of 7 million.

The Kaiser Family Foundation, a health policy research institution, has ranked New York’s exchange as the most competitive of seven states studied, based in part on the large number of companies participating and their relatively balanced market share.

In an unusual decision that had a strong impact on consumer choices, New York required insurers to offer the same type of coverage on the exchange as off.

The result was that none of New York’s insurers offered out-of-network coverage for individuals, except in a small part of western New York, because they wanted to hold down costs and avoid being swamped by sick people. So regardless of whether individuals buy their plans on the exchange or off, they cannot get coverage outside a fixed network of doctors and hospitals, even if they are willing to pay more for it.

With no out-of-network coverage, “New York is a real outlier,” said Mr. Scherzer, who advocates more options. “But they did it in part because they thought it would keep premiums down, which of course it does,” he said.

State officials say the decision served to level the playing field for insurance companies and consumers. But it has led to complaints from consumers who cannot go to the doctors or hospitals they want.

The sickest customers tend to be the most upset, like Abigail List, a 53-year-old therapist in Manhattan, who said she had to choose one of the most expensive plans, costing $300 more a month than others, so she could have coverage for her longtime cancer doctors at NYU-Langone Medical Center. “I’m being railroaded, that’s why I’m so furious,” Ms. List said.

The most prestigious and specialized hospitals tend to take the fewest plans on the exchange. Memorial Sloan-Kettering Cancer Center, the renowned cancer hospital, takes only two exchange plans for individuals, Health Republic and Oscar.

“It’s fairly difficult to take the pricing that some of the other insurers on the exchanges are proposing,” said John Gunn, the chief operating officer for Sloan-Kettering. “It was way below our cost of providing the service.”

He said Sloan-Kettering was working with about 100 patients to make sure they had access to the hospital if they needed it, either by being in network or by special arrangement.

Benjamin Lawsky, the state’s financial services superintendent, said that not requiring out-of-network coverage was strategic in the first year but was being reconsidered. “As we think about setting rates for Year Two, has the exchange matured enough that we think it’s wise to mandate an out-of-network benefit?” Mr. Lawsky said. “We’ll make that decision probably in the next few weeks.”

The exchange also benefited from the state’s refusal to reinstate canceled plans when President Obama said it could; state officials said restoring the plans would have caused chaos by upsetting insurance pricing.

The state’s rollout was not without snags. Its website was swamped on the first day but capacity was quadrupled over the next four days.

Some doctors have complained that they are mistakenly listed in plans they do not accept, or have been cut from plans they would like to be on. Empire BlueCross BlueShield, overwhelmed by early sign-ups, agreed to pay cash penalties to about 20,000 customers who did not receive their insurance cards in time for coverage in January.

But others were surprisingly willing to forgive the exchange its shortcomings.

Marilyn Miller, a retired ballet dancer who now runs Pilates on Hudson in Peekskill, N.Y., had her old plan canceled. But she is happy that her new one covers regular doctor visits, and she is putting money into a health savings account in case she ever needs to see a specialist outside of her network.

“It was well worth it to be able to get insurance and not have it tied to my business,” Ms. Miller said.

Malka Percal, 63, a copy editor who lives in downtown Manhattan, lost her freelancer’s plan and her “really wonderful” doctor. But she likes the promise of universal health care. “Is it Pollyannaish of me?” she said. “I have a really hopeful feeling.”

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