June 25th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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My husband’s brother is a police supervisor in Rochester, New York. I guess that gives new meaning to “brother-in-law?” Sorry, bad joke. But on a more serious note, I recently had the chance to interview him about his work experience with the mentally ill.
What surprised me about our discussion is that his perspective on life, as a law enforcement officer, seemed to mirror that of the physicians I know. He touched on the rampant lack of personal responsibility in this country, and how HIPAA rules can lead to unintended consequences (like endangering neighborhood children). I’m grateful that men like my brother-in-law are willing to put up with the seedier side of life every day, so that others can enjoy a reasonably safe existence. See what you make of his point of view. Do you see parallels with medical practice?
Dr. Val: What sort of interaction do you have with mentally ill individuals? Are you trained to handle them differently?
Sergeant Zlotkus: People call us all the time to complain about individuals with certain mental disorders – either for bizarre behavior or for being threatening and disruptive. We have daily contact with local mentally disturbed individuals so we generally know which ones have the potential to be violent. We also have an EDPRT (Emotionally Disturbed Person Response Team) that is trained to deal with the mentally ill. The usual police response of just “going in and getting yes or no answers” doesn’t work well with a disturbed person who doesn’t know how to handle emotions. There are times where reaching out to grab someone’s wrist can cause them to go berserk and bang their heads on your police car.
More and more people with mental health issues [that cause violent behavior] are being released into the public and officers are getting hurt. People often think that the police are not dealing with the issue because they see the same people on the streets again and again. The fact of the matter is that we take them into detention but once they’ve been evaluated in the hospital, the mental health professionals choose to deal with them as outpatients and they’re right back out in the community again. We can’t put these people in jail, and knowing what to do with them can be a really tough judgment call.
Where do you draw the line? Just because you’re annoyed with someone’s actions – is that enough to lock them up? If a person paces back and forth in front of your drive way four hours a day, does that mean they have to be taken away by the police? What if that’s their only offense and the other 20 hours of the day they are fine?
How do we make this situation better?
Sgt. Zlotkus: What would really help is community education – it’d be great if we could let people know about certain individuals, and whether or not their unusual behaviors should be cause for alarm. For example, a young man with autism might be treated with understanding and tolerance when he expresses unusual behaviors, but a person with a history of mental disorders and violence should be viewed with caution. People should have a lower threshold for requesting police intervention in that case. However, because of HIPAA, we’re not permitted to let anyone know anything about others mental health or potential risks to their family.
Dr. Val: Does HIPAA affect police safety?
Sgt. Zlotkus: Absolutely. We are not allowed to save data related to individuals’ health information – so that when known drug users (who have Hepatitis C) are arrested they may try to spit on us or bite us to transfer their infection.
We’re told to use “universal precautions” with everyone – but it’s simply not practical to go into every situation with face masks and rubber gloves. It’d be really helpful if we could protect ourselves and others with the knowledge of what the risks really are.
Dr. Val: Is burnout a problem in the police force?
Sgt. Zlotkus: I’ve been a police officer for 18 years. Two of my close colleagues committed suicide during that time period. There is a sense of burnout or frustration that we all get after a while because we see the same people committing crimes over and over again. Since I’ve been working the same beat for so long, I’ve actually seen three generations of dysfunction in certain families. The drugs and violence are transferred from parents to children and it perpetuates itself. Also, people call 911 for the silliest problems and we need to respond. One woman called us because her 5 year old was having a tantrum. I felt like telling the woman to put her child in the corner and give him a time-out – what are the police supposed to do about it?
The overuse of the police force by a small minority of people who know how to work the system can be frustrating. Some people bump their lip and then have EMS, the fire department, and the police department show up and take them to the ER. When you see the abuse of the system over decades, it can really wear on you.
Dr. Val: What would improve your work life? More funding for more police?
Sgt. Zlotkus: That’s a tough question. On the one hand it would be great to have more police helping with all the work, but on the other, if we doubled the police force and were able to arrive at every request within 60 seconds, there would be a whole new batch of people ready to call us for their every whim. More police would just mean more abuse of the system.
Dr. Val: What’s the biggest problem facing police today?
Sgt. Zlotkus: Nobody wants to take responsibility for their own actions. They want to blame others, sue anyone they can, or just let the government take care of them. Most people just don’t know what it means to be a good citizen anymore.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 12th, 2008 by Dr. Val Jones in Opinion
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I’ve written about raw milk before, but here again we find it making front page news. There has been a recent FDA raw milk crack down in California, and I believe that’s a good thing for public health reasons. Although raw milk enthusiasts ascribe mystical powers to the product (some say its natural microbial flora can cure everything from asthma to autism), I don’t see anything mystical about the pathogens that can grow in room temperature milk: e. coli, salmonella, listeria and even tuberculosis. If you like the taste of raw milk and don’t mind the risks associated with imbibing warm body fluids of manure-encrusted bovines… then go right ahead. But please, don’t put your children at risk.
The New York Times exposed the raw milk counter-culture phenomenon last year. Grocery store milk has been heated and packaged in a nearly sterile fashion so that no harmful bacteria are in it. Farmers collect raw milk from cows, then send it to a processing plant where it’s pasteurized (a heat treatment) and homogenized (blending the creamy part with the skim part) it before packaging the milk for human consumption. This process has virtually eliminated milk borne illness in this country, but now certain farmers are threatening to reverse that progress.
So why are people fascinated with raw milk and seeking out farmers who will sell them milk prior to heat treatment? Raw milk does taste very good, and there’s no doubt that the creamy layer that floats on the top is delicious. In New York City raw milk has a black market, cult following. Should you jump on the bandwagon?
As my regular readers know, I grew up on an organic dairy farm, and had the pleasure of handling cows up close and personal for at least a decade. In fact, their sweet-smelling grass breath, and not so sweet-smelling cow patties are etched permanently in my mind. Cows are curious, somewhat dim witted, and generally oblivious to the terrain upon which they tread.
Cows will stand in manure for hours without a moment’s regret, should you present them with fresh hay to eat or some nice shortfeed. They drop patties on the ground, in their troughs, and occasionally on one other. Their flicking tails often get caked with manure as they swish flies away and they scratch their udders with dirty hooves as well.
This is why when it comes time to milk them, farmers need to wipe their udders carefully with a disinfectant scrub before applying the milk machine. Mastitis (or infection of the udder teets) is not uncommon, and is a reason for ceasing to milk a cow until the infection has cleared.
And so, the cleanliness of raw milk depends upon whether or not the farmer removes all the excrement carefully, scrubs the teets well, and remembers not to milk the cows with mastitits. It also matters whether or not the cows are harboring certain strains of bacteria – which often don’t harm the cow, but cause very serious problems for humans.
Did I drink raw milk as a kid? Occasionally, yes. Were my parents super-careful about the cleanliness of the milk? Yes. Did I ever get sick from raw milk? No. Would I give raw milk to my kids? No.
I appreciate that epicures want to experience the flavor of raw foods, but for me, the risks are simply not worth it when it comes to milk. There is no appreciable nutritional benefit to drinking raw milk (in fact, store bought milk is fortified with Vitamin D, which is critical for healthy bones), and it caries a small risk of serious infection. I agree with the FDA’s ban on interstate sales of unpasteurized milk, and would not want to see raw milk available widely for general consumption. Of course, to get around this ban, some companies are selling raw milk and cheese under the label “pet food.”
It’s a crazy country we live in – anti-bacterial hand wipes, soaps, gels, plastics and an insatiable appetite for raw milk. As a doctor, I throw up my hands. Is raw milk getting a raw deal? Some farmers may feel that way – but this former farmer is pleased to have access to safe, clean milk. What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 12th, 2008 by Dr. Val Jones in News
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I’ve been following this story with interest and concern. A little birdie told me that Katie Couric has prepared a special report about the potential link between vaccines and autism for the CBS news tonight (May 12th). Sharyl Attkisson will be interviewing Dr. Bernadine Healy, former head of the National Institutes of Health, about her perspective. The CBS website has a 5 minute video clip now available on their site.
While I certainly agree with Dr. Healy that science must not be stifled, and that it’s fair game to research any environmental factor that could plausbily be related to autism, I am deeply concerned that the potential harm induced by vaccines (on kids with rare genetic disorders) will be generalized inappropriately and parents will refrain from vaccinating their children. We are already beginning to see Measles make a comeback (a disease with that can be fatal or cause irreversible brain damage) due to lower vaccination rates, and this trend may continue. Unvaccinated kids are not just a threat to themselves (because they’re at much higher risk for developing preventable diseases) but a threat to vaccinated kids as well, since vaccines are not 100% effective.
What do you think about the CBS segment? Watch it with me and we can discuss it here on my blog. Robin Morris, mother of a child with autism and a patient advocate at Revolution Health, will weigh in as well.
*Update: the full script is here*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 12th, 2008 by Dr. Val Jones in Celebrity Interviews
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I had the chance to interview diabetes spokesperson and Hollywood A-lister, Maria Menounos, at a recent diabetes conference. Prior to the interview I was given her Entertainment Industry Foundation biography for my review. Most of the biographies that I see belong to physicians and health policy experts – so it was an interesting change to read an entertainer’s biography.
Of note, Maria is a featured reporter on The Today Show and Access Hollywood – she has directed and produced several films and was listed in People Magazine’s “50 Most Beautiful People.” She also landed in the top five of the askmen.com poll for “the girl men most want to marry” along with Angelina Jolie and Charlize Theron.
But don’t let her beauty fool you – Maria has struggled with poverty, a chronically ill father, and her own weight issues. I enjoyed getting to know her better, and to learn about why she is such a passionate advocate for diabetes awareness. Enjoy our chat!
Dr. Val: Tell me a little bit about your dad’s diabetes and how you’ve been helping him to manage it.
Maria: My dad has type 1 diabetes, and he’s quite unusual in that he is extremely compliant with medical advice and dietary restrictions. He NEVER cheats. Many years ago he was told to avoid carbohydrates and so even when he was having a low blood sugar attack he’d refuse to drink juice to bring up his levels. Unfortunately my dad’s English isn’t so good (his native language is Greek and he has quite a language barrier with doctors) and I think a lot was lost in translation when he was given advice about how to manage his disease.
As a result of growing up in a poor neighborhood and not having access to more advanced medical care (along with the language barrier), my dad’s doctors were not particularly effective at communicating what he should be doing. My mom did her very best to follow their instructions religiously – she became his personal chef and kept him from eating carbohydrates.
My dad was in and out of the hospital all the time for low blood sugar, and because of a lack of coordination of care my family never realized why this was happening or what we could do to prevent it. So we were trying harder and harder to be more strict with his diet, which was in fact making the problem worse. My dad did janitorial work and would nearly pass out on the job due to a low carbohydrate diet. But since the doctors told him not to eat sweets or bread or pasta, he believed that his sickness was due to his not being strict enough, so he’d just eat less and less until he ended up weighing 140 pounds at 6 feet tall. My family was living in constant fear of him passing out again and needing to go to the hospital. We knew every ambulance worker and every fireman in our neighborhood by name because they were always at our house.
Finally when I moved to Hollywood and had some career success I was able to get my dad to a world renowned endocrinologist, Dr. Anne Peters. Within three visits she straightened him out and explained how he did in fact need to eat some carbs. She got his blood sugars evened out and he never had to be hospitalized again.
What scares me the most is what’s happening to people who have diabetes and language barriers. They’re at incredible risk for misinformation, confusion, and poor care. Imagine how many people in this country are just like my dad – trying to follow advice they don’t fully understand? This is a real problem that we often overlook in diabetes education.
Dr. Val: As a Hollywood insider, how aware are your peers about diabetes and is there much talk amongst them about getting involved in campaigns to reduce type 2 diabetes?
Maria: I’m sure they are but I haven’t come across that many. It doesn’t come up that frequently. There haven’t been any breakthroughs in insulin therapy or any other huge scientific advances in diabetes care so the topic isn’t that newsworthy or “sexy.” It’s a real shame that it isn’t talked about more. Everyone seems to be aware that type 2 diabetes is preventable but no one seems to know how to do so. They don’t realize that you need to lose weight and exercise. But I learned about that when I had a weight problem.
Dr. Val: YOU had a weight problem?
Maria: As I said, I came from a diabetic home. We ate vegetables fresh from the garden every day and my mom was extremely careful about what we ate. We didn’t eat anything bad. My mom would buy ice cream and Doritos like, once a year when family was coming over. I didn’t even know what a bagel or a waffle was for most of my time growing up. Then I went to college and there was endless all-you-can-eat food. So over 3 or 4 years of eating pizza and I ended up gaining 40 pounds. One day I decided that I wanted to move to California and get into the business and I realized I needed to lose the weight.
I wrote down everything I ate in a week, and I realized that my problem was carbs. So I cut them back substantially and the weight just melted off. I lost about 20 pounds in several months, and then I added exercise to get the last 20 off. I’ve never looked back.
Dr. Val: How can we be more effective in getting Americans involved in their own health?
Maria: First of all, I think that we need to focus on educating children about healthy lifestyle choices. We have to get the message to them early. Kids enjoy knowing more than their parents and teaching them something new. So it’s really empowering for kids to learn about nutrition and then bring that knowledge home to their families and teach them a thing or two.
Obviously getting Americans to be more involved in their health is a very difficult challenge. Many people are struggling to get by and don’t have time to put their health first – they have to focus on work, paying their gas bill and putting food on the table. It will take a national, coordinated effort to really make a difference.
**Join Dr. Val’s Weight Loss Group**This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 5th, 2008 by Dr. Val Jones in Health Policy, Health Tips
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Do you know your state’s momScore? Revolution Health and I have teamed up with leading medical experts and mommy bloggers to create a new health index just in time for Mother’s Day: the momScore.
Check out this fun interactive map that ranks states by 10 key maternal health variables*:
- Access to prenatal care
- Availability of childcare services
- Number of insured moms
- Maternal mortality
- Affordability of childrens’ health insurance
- Air quality
- Family paid leave policy
- Infant mortality
- Risk of pregnancy complications
- Violent crime rate
We also created a combined average of these variables (weighted according to expert perceived importance) to get an overall ranking. So, do you know where it’s best to be a mom in the United States?
Apparently, Vermont ranks most favorably (on average) in all of these variables. Don’t live in Vermont? Check out how your state compares.
Would you like to discuss your state’s rankings with others or debate the momScore? You can post your comments in our interactive momScore community. This is a really exciting opportunity to discuss women’s health issues in a fresh new way. I hope that the momScore will challenge states to strengthen their efforts to keep moms and babies healthy. At the very least, we’ve made a lot of Vermonters quite smug.
*Variables are based on state reporting to the Environmental Protection Agency (EPA), the Centers for Disease Control and Prevention (CDC), and the United States Census Bureau, as well as leading non-profit organizations such as the Kaiser Family Foundation and the American College of Obstetricians and Gynecologists. For more information about momScore methodology, click here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
