Wednesday, June 24, 2009

Last Child in the Woods

That's the name of a book by Richard Louw, subtitled, "Saving Our Children from Nature-Deficit Disorder." The book "bring[s] together a new and growing body of research indicating that direct exposure to nature is essential for healthy childhood development and for the physical and emotional health of children and adults. More than just raising an alarm, Louv offers practical solutions and simple ways to heal the broken bond—and many are right in our own backyard."

I haven't yet read it, but I want to do so. As a lifelong city kid, I really felt this deficit last week, when my mom and sister were visiting. We spent three days staying in a cabin owned by my boss on the Olympic Penninsula here in Washington state that is surrounded by woods.

I went to day camp once as a child, when I was six. I had such a bad allergic reaction to the pollens in the woods that my eyes swelled shut--and my mother never sent me to camp again. As an adult, I've gone camping a few times, but always in campgrounds that had indoor restrooms and showers--no real roughing it. So my knowledge of nature is limited.

I really felt that lack as we walked through the woods around my boss' cabin with my daughter. Curious child that she is, she wanted to look at and touch everything, and I often stopped her. I was afraid of things such as dangerous insects, poisonous berries (since she often puts such things in her mouth), and poison ivy. My problem is, I don't know how to recognize what is safe and what is dangerous in nature, and what to do if I encounter such things. My logical response then, is to overprotect my daughter.

I'd like her to be more free to explore and experience nature, but it will take a lot more knowledge on my part (or that of someone else who can teach her).

In praise of local food

Two days ago, hubby and Johnny (one of our new friends from the Tacoma Food Policy Council) spent the day working at our elderly gentleman friend's farm, and returned with a 30-gallon trash bag of newly picked collard greens.

I am used to eating collard greens that need to be cooked for hours in order to be tender enough to eat, and that need lots of additional stuff added (hamhocks, vinegar, hot sauce) in order to taste good.

Not these! First, my daughter sampled one of the raw leaves, and then the rest of us (hubby and I, my mother-in-law and sister-in-law, Johnny and his wife Michelle) followed suit. The leaves were delicious as is. Then hubby cooked a pot, with just a turkey neckbone added, for just an hour. These were the tenderest, sweetest collard greens that any of us had ever eaten!

I wonder how much we miss in terms of flavor and texture, because so few of us today really get to eat truly fresh, local food?

Friday, June 19, 2009

MyChelle Minerals Makeup

A shout-out to MyChelle Minerals, from whom I received a free makeover at Super Supplements yesterday. According to their web site, their products are "always free from phthalates, parabens, propylene glycol, ureas, EDTA, fragrances, encapsulated nano particles, and artificial colors." This is great, because while I'm happy with my skincare routine, I hadn't yet found a natural makeup line that I liked. And they did a really nice job with the makeover!

Bad move by Pierce County Transit

I mentioned way back in one of my early posts that taking public transportation here in Tacoma is much tougher than back in Boston. My mom and sister, who returned yesterday to Cleveland and New York City, respectively, after their visits here, commented about the public transit difficulties they encountered when they tried to tour Seattle--ironic, since Seattle is generally considered a very green city.

I do quite a bit of traveling on the bus here in Tacoma, which can get me to many places I want to go. However, there is only one bus line in walking distance from my home, and it runs once an hour during the week, and not at all during weekends and holidays. So generally, if hubby has the car (which is most of the time), he drops me off at a mall that's a 10 minute drive from our home (but about an hour walk), where I can catch a bus that runs every 15 minutes, and delivers me to my job and many other key locations in Tacoma.

Yesterday, I took the bus that drops me near my home, and the driver told the passengers that Pierce County transit is planning to drop the line. This means that for a major section of my community, we would have NO public transportation service. This means I would NEVER be able to go anywhere without a car. My husband can still drop me at the mall 10 minutes away, but what if he's not available? (His job requires a lot of travel). Again, my neighborhood is ranked at 7% walkability by the Walkable Neighborhoods score, with only a school, a golf course/park and an apple orchard within two miles from my home. And don't suggest biking: I haven't owned a bike since I was 14, Tacoma is extremely hilly, and my neighborhood has neither sidewalks nor bike paths. So biking for me would not be safe.

The bus driver suggested calling Pierce County Transit to complain, which I will do. I hope it helps.


Update: I called Pierce Transit the next day to voice my opinion. The woman I spoke with was very sympathetic, but said that discontinuing this route and several others was a tough decision they had to make based upon the current state of the economy. She said there were several public meetings held last year (when we were newly arrived in Tacoma and knew very little about the local scene) at which people got to advocate for their routes, and they used the information the public provided to make their decisions.

She said something else, too--one of the reasons for her sympathy is that her kids go to school along that route, and she knows that without it there is no bus service in the area. I thought about that--this bus passes right by my town's only junior and senior high schools. When my nephews were still here, the one in elementary school caught a school bus, but my husband and I spent a month driving my older nephew to high school, because the bus ran so infrequently. So how can you discontinue a bus route that serves a municipality's only schools for this age range--thousands of young people too old for school buses, but who may not be old enough to drive, and might not have cars even if they could?

A kindred spirit who's funnier than I am

From a link at Crunchy Chicken, I discovered Condo Blues today. Her tagline is, "Green Frugal Living That's Big on Style and Small on Budget." So the blogger is a kindred spirit in trying to go green on the cheap!

But even better, unlike my usual serious tone, she's funny! And totally relatable. Here she is in "Eco-confession," talking about the things she does that aren't green. She has a point: some things she does that aren't green are necessary in order to prevent worse eco-sins, e.g., wearing fleece so she doesn't have to turn up the heat, or buying non-organic and non-local because to get the local, organic stuff would require a lot more driving. In another great post, she talks about fighting green fatigue, and she's driven nuts by irritating green tips to!

Tuesday, June 9, 2009

Lettuce and a lighter posting schedule

My posting schedule may be light the next few weeks, because we'll have relatives in town. We'll finally do all the touristy things that you never do until someone comes to visit!

Meanwhile, I'm loving my homegrown lettuce and herb salads. I like salads in general, but I usually have to add a lot of stuff to them (such as nuts, grated cheese, fruit, or bacon bits) or they taste too bland. My lettuce, with just a small kick of fresh parsley, basil and chives (we're talking maybe 1-2 teaspoons combined, because my herbs aren't big enough for me to harvest a lot yet), tastes good just as is! I so wish I'd known that my wilting lettuce seedlings would have rebounded the way they did; I would have replanted more of them. The good news is, you can plant lettuce seeds again in late summer for a fall harvest.

Addressing health care costs

One of the speakers at the Tacoma Health Care for All rally made the point that although our nation needs single payer healthcare yesterday, if we implemented it tomorrow, the U.S. would go bankrupt. That's because our health care system as it currently exists is very inefficient, and if we don't address the inefficiencies, single payer is doomed to fail. He mentioned a few possibilites for reining in costs, among them the option that every medical visit doesn't require a patient to see a doctor, because nurse practitioners and physician's assistants can often address their needs.

In the June 1, 2009 edition of The New Yorker, Dr. Atul Gawande addresses this issue in his article, "The Cost Conundrum." Dr. Gawande is a general and endocrine surgeon at Brigham and Women's Hospital in Boston and associate director of their Center for Surgery and Public Health, and he is an associate professor at both Harvard Medical School and the Harvard School of Public Health.*

In his article, Dr. Gawande decides to explore the issue of exploding health care costs by examining the second most expensive health care market in the country, Hidalgo County, TX, of which McAllen is the county seat (the highest is Miami, which is a much more expensive location overall). Health care spending in nearby El Paso County is half that of Hidalgo County, even though the two counties are of similar size and have similar demographics.

He explores several explanations for the high cost of medical care in McAllen, and finds most wanting. The residents are not sicker than in most places: rates of cardiovascular disease, asthma, HIV, infant mortality, cancer and injury are lower than national averages. Nor are the residents receiving unusually good health care: the five largest hospitals in Hidalgo County perform worse on all but two of 25 metrics of care in comparison to the hospitals in the much less expensive market of El Paso. And because of tough malpractice laws in the state of Texas, there are few medical malpractice suits driving up costs.

Dr. Gawande finally concludes that the reason for the high costs is because "patients in McAllen got more of pretty much everything--more diagnostic testing, more hospital treatment, more surgery, more home care." When he pointed this out to medical practitioners and hospital executives, they were surprised, and then concluded that this was happening because they are providing their patients with better care than elsewhere.

Not so, argues Dr. Gawande. He cites a 2003 study by Dartmouth University that shows that elderly patients in higher health care spending regions tended to receive more high-cost medical care, with equal or lesser results than in lower-spending regions. The reason for the lesser results? Almost all medical care carries risk, and the more expensive, complicated and/or invasive the care, the greater the risk. Thus, if a procedure isn't absolutely medically indicated, the treatment might be worse than the disease.

In addition, patients in higher spending regions were less likely to receive low cost preventive care services. So patients in high spending areas receive more risky care, with fewer services that would keep them from getting sick in the first place.

Dr. Gawande says, "In an odd way, this news is reassuring. Universal coverage won't be feasible unless we can control costs. Policymakers have worried that doing so would require rationing, which the public would never go along with. So the idea that there's plenty of fat in the system is proving deeply attractive." He goes on to note that some of the regions with the highest quality health care have costs lower than national averages, and if we could bring down spending and increase quality to match those regions, most of our health care (and federal budget!) problems would be solved. The question is how.

One of the problems he notes is that those who oversee most health care facilities are concerned about the bottom line, not quality of care. More patients, more procedures generally equals a better bottom line. This is not to cynically suggest that they care nothing about patients, but as Gawande put it, "[Hospital and clinic execs] have only the vaguest notion of whether the doctors are making their communities as healthy as they can, or whether they are more or less efficient than their counterparts elsewhere. ... [T]he best possible treatment for the patient... isn't what [the execs] are responsible or accountable for."

Patient care decisions more frequently fall to doctors, who can make widely different decisions about how to treats patients with similar health care issues, often depending on where the physican is located. Some of these differences are attributable to how the doctors are trained. But many of the differences come down to money.

Physicians, Gawande said, have different relationships with the money generated by their practices:

1) some are oblivious to it, just making the best decisions for patients they can;
2) some see money as a way to improve their practice. The more money they generate, the more they can do for patients, through improved equipment, adding additional staff, etc.
3) others see their practices as ways to increase their revenue stream, and will prescribe and offer more high-cost services and procedures to do so, over providing low-cost preventive care.

Which category a doctor falls into depends partly on each individual's personality and ethics. But it also depends partly on the culture of the medical community where the doctor practices. Gawande brings up the concept of "anchor" institutions: leading institutions in a region, which, given their strong influence, set the tone for the values in the given field throughout the community.

He then looks at several regions that provide high quality, low cost medical services, and explores this further. For example, in Rochester, MN, where Mayo Clinic is headquartered, the core tenet is, "The needs of the patient come first." Gawande also describes several other such communities, where, in addition to a "patients before profits" set of values, there is also an "accountable care" ethic, in which the leading medical providers adopt "measures to blunt harmful financial incentives" and take "collective responsibility for improving the sum total of patient care." (Something Gawande doesn't mention explicitly is that the best "accountable care" organizations he cites are not-for-profit).

"Harmful financial incentives" include such things as fee-for-service rather than salaries, and doctor investment in profit-sharing for their institution, both of which encourage doctors to over-provide services in order to get paid more. "Collective responsibility" refers to doctors (and other hospital/clinic/home care staff) working as teams to determine the best care for patients, and to prevent unnecessary procedures. He compares it to building a house: you hire a contractor who puts together a team, including architects, carpenters, electricians, plumbers, etc. If each of these groups worked independently, the costs would escalate dramatically, and your house would probably fall apart.

Gawande recommends rewarding doctors and hospitals that "band together to form ... accountable-care organizations [that] collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering." A possible reward could be public and private insurers allowing such groups (if they meet quality goals) to keep half the savings they generate, or the government removing some of the burden of malpractice liability. Bottom line: unless we change the way medical providers do business, health care reform will fail, no matter who's paying for it.**


* Reading Dr. Gawande's bio on Wikipedia, I wondered if my sister or husband know him. He grew up in Ohio, as we did, and was in the same Stanford class as my sister. Also, my hubby used to work at Brigham and Women's hospital, and had his open heart surgery there. He said his pre-surgery anxiety was eased when it turned out that the anesthesiologist was one of the friends he made when he worked there.

** I wonder if this is a "chicken and egg" thing. Did insurers trying to increase profits push doctors toward profiteering, or was it the other way around? I think it's the other way around. A young man at the rally, a LaRouche follower (!), told me that in the U.S. most medical facilities were non-profit, as were health insurance companies, until the '70s and '80s eras of deregulation. If that's the case, can you change one without changing the other?

Friday, June 5, 2009

Is it too soon to declare victory?

The weather has been absolutely phenomenal for the past couple weeks here in Tacoma, and my plants are thriving! Every day this week, I've clipped a few leaves of lettuce and some herbs for salad (and it was yummy!), and my daughter's sunflower plant has revived outdoors. My spinach (which I planted in a container outdoors about a month after the rest) is budding and growing, although it's too soon for a harvest there.

Given what I wrote months ago about my previous failures with growing things, can I declare a victory yet?