2006 Programs

This week's show is a re-broadcast of last December's documentary on land mines and their victims. Dr. Marvin Malek explores the public health impact of land mines and unexploded ordnance. He interviews survivors of land mine explosions, doctors and other health personnel who care for them, public health activists, a representative of the U.S. government, and individuals who clear lands of buried mines.

Dr. Joanna Santa Barbara, child psychiatrist and professor at the Centre for Peace Studies at McMaster University in Hamilton, Ontario, describes the academic discipline -- and practical public health intervention -- called Peace Through Health [ http://www.humanities.mcmaster.ca/peace-health/ ]. This program has evolved out of work in Croatia, Gaza, Sri Lanka and Afghanistan. In this interview Dr. Santa Barbara describes Peace Through Health efforts in Afghanistan, in which ongoing mental health intervention for children has led to a dialogue for peace with politicians on all sides of the conflict. Dr. Santa Barbara also discusses the larger topic of war and public health. She explores how the public health concepts of primary, secondary and tertiary prevention can provide a framework for understanding how interventions may lessen the "public health disaster" brought by war -- by ameliorating human suffering, bringing about humanitarian cease fire and preventing new wars from starting. A founding member of Physicians for Global Survival, Dr. Santa Barbara is also a leader of International Physicians for the Prevention of Nuclear War.

Dr. Marvin Malek, internal medicine and public health physician in Barre, Vermont, speaks to us about his decision to run for Lieutenant Governor in the 2006 election. Dr. Malek decided to take a leave of absence from Public Health Radio, which he pioneered, in order to focus on his political campaign. He poignantly reflects on the events that led to his decision to run for public office. He describes personal daily frustrations in his political campaign as well as in his interactions with private insurance companies in what he calls our "dysfunctional health care system." Dr. Malek explains how the Vermont House passed a bill for a single statewide insurance fund that would cover all Vermonters in 2005, and in 2006 arrived at a bipartisan compromise plan called "Catamount Health," a scheme to expand private insurance through a combination of funds from Medicaid, a tobacco tax, and a "disease management" initiative. He reflects on what it is like to try to articulate a message for health care reform as well as a broad public health message through media, as a candidate in an election campaign and as the host of a radio program.

Public health radio presents an interview with Marilyn Metzler, RN, of the Centers for Disease Control and Prevention (CDC) Division of Adult and Community Health. Ms. Metzler leads a team of federal agencies and other partners charged with updating and refining the Community Health Status Indicators (CHSI) resource. A national database with a range of county-level data, the CHSI resource compiles an array of health indicators, from diabetes and cancer prevalence to environmental, employment, housing, economic, and education measures. We discuss how the CHSI resource can be used to monitor and assess community conditions in hopes of improving health outcomes. We explore an expanded vision of health that moves us beyond the medical model to consider social determinants of health. We also touch on several projects, domestic and international, that are currently underway and are guided by a holistic vision of health influences.

We ask Walter Tsou, MD, MPH, immediate past president of the American Public Health Association, to address the big question of public health in America. Dr. Tsou discusses the public health infrastructure, the need to eliminate health disparities, the importance of universal and equal access to care, the need to provide culturally appropriate medical care and along the way issues a call for personal engagement with public health issues. Dr. Tsou, a consultant on national issues of public health and visiting professor at the University of Pennsylvania, provides a compelling vision of the fundamental importance of public health to medicine and society and a passionate defense of public service.

Over the last five years or so, media attention has focused on the increasing prevalence of obesity, and diabetes as two consequences of the processed, high protein, high fat diet prevalent in the United States, and the sedentary American lifestyle. But there has been less attention directed toward another silent problem that is also a predictable consequence of these lifestyle changes---osteoporosis. Osteoporosis is a disease of bone that predisposes to fractures, often with devastating consequences to the lives of those it affects. Osteoporosis is especially common among elderly women, who are the fastest growing segment of the population. But osteoporosis is a condition that develops very gradually over decades, so that even our lifestyle during youth and early adulthood can have important consequences for the health of our bones later in life. Rose Christian joins us on show #66 to discuss osteoporosis, and its causes, prevention, and treatment. Rose Christian, MD is a medical doctor in the field of internal medicine with a special interest in women's health. After practicing for several years, she undertook advanced training in the area of endocrinology and bone physiology at the at the National Institutes of Health and at the Mayo Clinic in Rochester Minnesota. She currently works at the University of Vermont, where she serves as an Assistant Professor, and helped to create a special clinic which focuses on diseases of bone. Some useful websites on osteoporosis include the Hormone Foundation, with fact sheets, an overview of osteoporosis, and results of recent research, accessible at www.hormone.org . The National Osteoporosis Foundation is an advocacy group that lobbies for improved screening and care for osteoporosis patients, and useful information on the disease. Their web address is www.nof.org .

For the last few years, increasing attention has been focused on the pharmaceutical industry. Television advertising has been taken over by slick pharmaceutical advertising imploring us to "Ask our doctor" about any number of drugs which in the past we might only have heard about at a medical visit. And it was hard not to take note that the cost of the prescription drug benefit under the new Medicare Reform Act will cost the taxpayers hundreds of billions of dollars. Year after year, the pharmaceutical industry ranks among the top five most profitable industry sectors. And for every one of the last ten years, the prices of prescription drugs have been rising far faster than the consumer price index. All that might seem acceptable if we were confident that all these drugs are really helping to prevent or treat important illnesses. With the publication of the results of the Womens Health Initiative in 2002, we discovered that after years of promoting hormone replacement for post-menopausal women as able to stave off everything from dementia to heart disease, it turned out that there was little truth to the optimistic health claims we'd been hearing from the drug companies. The question is whether the case of hormone replacement therapy is unique. John Abramson joins us on Public Health Radio for Shows 64 and 65 to explore this issue in detail. On Show #64, Abramson documents that the distorted research and groundless claims made about hormone replacement therapy applied also to Vioxx, Celebrex, and to drugs used for dementia and cholesterol treatment. He also reviews the history of the gradual infiltration of the medical research establishment by commercial interests, especially the pharmaceutical industry. He then lays out a proposal for the creation of a new federal agency to oversee the quality and integrity of medical research and clinical practice guidelines Dr. Abramson discusses the next steps in this process on Show #65---the dissemination of commercially-slanted medical information to doctors on the front lines of patient care, and also to the population at large. He describes the events that led to this commercial takeover, and what both doctors patients, and citizens in general can do to improve the quality of medical information, and their own health as well. John Abramson is a medical doctor -a family practitioner. For many years, he served as Chairman of the Family Practice Dept at the Lahey Clinic. For many years, he has served on the faculty of Harvard Medical School. An area of special interest to Dr. Abramson is the central importance of the relationship between patients and their primary care practitioners in producing good therapeutic outcomes. But increasingly over the last five years, Dr. Abramson has turned his attention to the near complete permeation of commercial interests into the creation and dissemination of medical knowledge. In 2004, he completed his groundbreaking book addressing this issue: Overdosed America. Overdosed America is available through many book outlets, and can be obtained through the website, http://www.overdosedamerica.com.

For the last few years, increasing attention has been focused on the pharmaceutical industry. Television advertising has been taken over by slick pharmaceutical advertising imploring us to "Ask our doctor" about any number of drugs which in the past we might only have heard about at a medical visit. And it was hard not to take note that the cost of the prescription drug benefit under the new Medicare Reform Act will cost the taxpayers hundreds of billions of dollars. . Year after year, the pharmaceutical industry ranks among the top five most profitable industry sectors. And for every one of the last ten years, the prices of prescription drugs have been rising far faster than the consumer price index. All that might seem acceptable if we were confident that all these drugs are really helping to prevent or treat important illnesses. With the publication of the results of the Womens Health Initiative in 2002, we discovered that after years of promoting hormone replacement for post-menopausal women as able to stave off everything from dementia to heart disease, it turned out that there was little truth to the optimistic health claims we'd been hearing from the drug companies. The question is whether the case of hormone replacement therapy is unique. John Abramson joins us on Public Health Radio for Shows 64 and 65 to explore this issue in detail. On Show #64, Abramson documents that the distorted research and groundless claims made about hormone replacement therapy applied also to Vioxx, Celebrex, and to drugs used for dementia and cholesterol treatment. He also reviews the history of the gradual infiltration of the medical research establishment by commercial interests, especially the pharmaceutical industry. He then lays out a proposal for the creation of a new federal agency to oversee the quality and integrity of medical research and clinical practice guidelines Dr. Abramson discusses the next steps in this process on Show #65---the dissemination of commercially-slanted medical information to doctors on the front lines of patient care, and also to the population at large. He describes the events that led to this commercial takeover, and what both doctors patients, and citizens in general can do to improve the quality of medical information, and their own health as well. John Abramson is a medical doctor -a family practitioner. For many years, he served as Chairman of the Family Practice Dept at the Lahey Clinic. For many years, he has served on the faculty of Harvard Medical School. An area of special interest to Dr. Abramson is the central importance of the relationship between patients and their primary care practitioners in producing good therapeutic outcomes. But increasingly over the last five years, Dr. Abramson has turned his attention to the near complete permeation of commercial interests into the creation and dissemination of medical knowledge. In 2004, he completed his groundbreaking book addressing this issue: Overdosed America. Overdosed America is available through many book outlets, and can be obtained through the website, http://www.overdosedamerica.com.

Public Health Radio presents the second in a two part series on the "Medicare Prescription Drug Improvement and Modernization Act of 2003" enacted in December, 2003. We start the show with a report from Al Laprade, a Medicare enrollee and patient of Dr. Malek, who catalogues the prescription drug costs he faces each month, and describes the actions he's taken to reduce those costs. Then Leslie Norwalk, the Deputy Administrator of the Center for Medicare and Medicaid Services, describes the mechanism the Medicare Reform Act relies on to negotiate prescription drug prices with the pharmaceutical companies. Because of their critical role in the Medicare Reform Act's prescription drug benefit, Public Health Radio next takes an in depth look at the pharmacy benefit management industry sector. Robert Garis joins us to discuss this industry sector, and reviews their track record in negotiating with the drug companies on behalf of private and governmental entities. Finally, Marvin Malek, host of Public Health Radio, provides a summary of the Medicare Reform Act, the likely impact on administrative costs and effort, and its potential to destabilize the Medicare insurance market. For more information on the Medicare program, including the reform act, the government's website in the Medicare program is http://medicare.gov. Critical analysis of the reform act is available at the Urban Institute's website www.urban.org, and at the Center for American Progress Medicare spotlight: http://www.americanprogress.org/site/pp.asp?c=biJRJ8OVF&b=24891 To learn more about the pharmacy benefit management industry, two articles co-authored by Dr. Garis are especially useful: 1 Garis R, Clark B, Siracuse M, & Makoid, M. Examining the Value of Pharmacy Benefit Management Companies. Am J Health-Syst Pharm. 2004; 61:81-85. 2 Garis R, Clark B. The Spread: Pilot Study of an Undocumented Source of Pharmacy Benefit Manager Revenue. J Am Pharm Assoc.2004;44:15-21. Leslie Norwalk JD is a lawyer, and the current Acting Deputy Administrator of the Center for Medicare and Medicaid Services, the agency that administers the Medicare program. Prior to serving in the current Bush Administration, she practiced law in the Washington, D.C. office of Epstein Becker & Green, P.C. where she advised clients on a variety of health policy matters. She also served in the first Bush administration in the White House Office of Presidential Personnel. Robert Garis, PhD is an Assistant Professor of Pharmaceutical Sciences at Creighton University in Omaha, NE. His primary research focus has been the pharmacy benefit management companies, and how that industry has impacted pharmacy costs. Marvin Malek, MD MPH is the host and co-producer of Public Health Radio.

NOTE: Beginning with this show, all programs will be made available as 128 Kbps MP3 files. We will no longer be transmitting 64 Kbps versions. DIABETES MELLITUS, THE MODERN EPIDEMIC. UNDERSTANDING DIABETES AND PREVENTING IT Robert Rizza discusses diabetes mellitus, a disease that is mushrooming in the United States and worldwide. We discuss the difference between the two types of diabetes, how diabetes is treated, and why it is becoming more and more common. We also look at personal and societal strategies to prevent diabetes. Robert Rizza, MD is a Professor in the Department of Medicine at the Mayo Clinic College of Medicine. Dr. Rizza is a specialist in the field of Endocrinology, with a research focus on the causes and treatment of diabetes mellitus. He currently serves as Vice-President of the Board of Directors of the American Diabetes Association (ADA). Many useful links on the topic are available at the ADA website http://www.diabetes.org REFORMING THE MEDICARE PROGRAM, PART 1: THE PRIVATIZATION OF MEDICARE Public Health Radio presents the first in a two part series on the "Medicare Prescription Drug Improvement and Modernization Act of 2003" enacted in December, 2003. This show looks at the incentives placed into the bill for private insurance plans and HMOs to participate in the Medicare program, as well as the incentives for patients to enroll in these plans. We discuss the implications on enrollees, on the future stability of Medicare, and on the overall cost of the Medicare program. Featured guests include Leslie Norwalk, Judy Feder and Robert Berenson. For more information on the Medicare program, including the reform act, the government's website in the Medicare program is http://medicare.gov. Critical analysis of the reform act is available at the Urban Institute's website www.urban.org, and at the Center for American Progress Medicare spotlight: http://www.americanprogress.org/site/pp.asp?c=biJRJ8OVF&b=24891 Leslie Norwalk JD is a lawyer, and the current Acting Deputy Administrator of the Center for Medicare and Medicaid Services, the agency that administers the Medicare program. Prior to serving in the current Bush Administration, she practiced law in the Washington, D.C. office of Epstein Becker & Green, P.C. where she advised clients on a variety of health policy matters. She also served in the first Bush administration in the White House Office of Presidential Personnel. Judy Feder, PhD is Professor and Dean of Georgetown University's Public Policy Institute. She also serves as Co-Director (with Sheila Burke) of the Georgetown University Long-term Care Financing Project, is a senior advisor to the Kaiser Family Foundation's Commission on Medicaid and the Uninsured, and is a member of the Commonwealth Task Force on the Uninsured. Her leading research and policy interest is in understanding and improving the nation's health insurance system. Robert Berenson, MD is a Senior Fellow at the Urban Institute. From April, 1998 until October, 2000 he was Director of the Center for Health Plans and Providers in the Health Care Financing Administration, now called the Centers for Medicare and Medicaid Services. CHPP was the focal point in HCFA for payment policy and operational issues related to managed care (Medicare +Choice) plans and health care providers. Dr. Berenson's research interests include Medicare, physician payment policy, managed care, and medical ethics. He has authored numerous articles on these topics, and coauthored The Managed Care Blues & How to Cure Them, a review and critique of health maintenance organizations in 1998.