2012 Election To Be Pivotal for Healthcare

November 15th, 2012

The 2012 presidential election will impact healthcare delivery in the United States. The question boils down to whether the electorate believes that the free market will control the cost of healthcare while delivering quality care.

According to The New Yorker’s James Surowiecki, “In most areas of the economy, free-market principles insure that products and services keep improving, and that consumers get better and better deals.”  Although the free market may be the optimal way to sell cars and refrigerators, it may not provide the same impetus for medical care.  Nearly half a century ago, Stanford economist Kenneth Arrow, in an article entitled “Uncertainty and the Welfare Economics of Medical Care”, suggested that healthcare is an outlier that limits the power of the marketplace.  Paraphrasing Arrow, Surowiecki writes that “Because people don’t have the expertise to evaluate doctors, hospitals or treatments, it’s hard for them to comparison shop.  Because they can’t pay for major care out of pocket, they must rely on insurance, often losing the final say in what to buy or how much to spend.  More fundamentally, markets work only when consumers have the power to say no if the price isn’t right.  Yet it’s very hard for people to say no in the case of things like end-of-life care or brain surgery.”

Surowiecki points out that, over the past four decades, Medicare has done a better job at holding down healthcare costs than the overall market.  He also notes that most developed nations – which have government-controlled healthcare –succeed at reining in costs while delivering first-rate outcomes.

Non-Profit Hospital Fundraising Soars in 2011

October 29th, 2012

More than $8.9 billion was donated to non-profit hospitals and healthcare systems in 2011 — an all-time high.   According to a report from the Association for Healthcare Philanthropy (AHP), that is an 8.2 percent increase over the previous year.  The recent numbers continue a trend that started in 2010 when non-profit hospitals saw an eight percent rise in donations compared with 2009 to more than $8 billion.  Individual donations totaled nearly 60 percent of that amount, according to the AHP.  That was a significant increase over 2009, when donations fell 11 percent or $944 million.

During 2011, the cost of fundraising rose to 31 cents per dollar collected, a two percent rise over the previous year.  Healthcare systems raised $3.24 for every dollar they spent.  University-connected hospitals were the most prolific, with $7.58 raised for each dollar spent.   Approximately 19 percent of donated funds supported community benefits and charity care; an additional 8.6 percent funded training and research.

Annual giving was the primary fundraising source, followed by capital campaigns and special events.  Approximately 70 percent of money raised was in the form of cash contributions, while the remainder was pledges primarily in the form of bequests and planned gifts.

Susan J. Doliner, chair of the AHP board of directors, notes that “It’s interesting to see that the funds raised continue to be predominantly in support of construction and renovations, equipment and program operations.  Stay tuned, as this finding shines a light on the future gap in resources healthcare organizations will face as we begin the implementation of new healthcare financing models.”  The uptick in donations is good news for hospitals and healthcare systems working to accommodate millions of new patients when the Patient Protection and Affordable Care Act (ACA) becomes fully effective in 2014.  At present, healthcare systems are relying on capital campaigns to finance new construction rather than bank loans or other debt.   Only 17 percent are using debt, a decline from the 20 percent reported in 2010.  Another 42 percent are financing new facilities with cash reserves.  The use of tax-free bonds is at its lowest level in six years, comprising just 21 percent of new construction financing.

Craig Wortmann on Creating Your Business Story

October 15th, 2012

According to Craig Wortmann, Clinical Associate Professor of Entrepreneurship at the University of Chicago Booth School of Business, people today tend to collect too much information – via Facebook, blogging, tweeting, reading other people’s blogs – information overload typically becomes a problem shared by humanity.  In a recent interview for the Alter+Care Inspire Podcasts, Wortmann said that while the technique of telling stories is the oldest form of communication — it’s also the one form that rises above the din of our information-saturated environment and delivers messages that connect with people, bringing ideas to life.

Wortmann is founder and CEO of The Sales Engine and the author of the book “What’s Your Story?”, which discusses how to use stories to ignite performance and be more successful.

Wortmann believes that we are reaching back to our earliest human ancestors whose cave drawings created a narrative structure – stories that remain compelling through the ages.  We still create stories to make daily experiences meaningful for people, to differentiate them from what Wortmann calls facts or data.  Stories do two things:  they create context and provide an emotional connection.  By “emotional”, Wortmann doesn’t mean fluffy or characterized by high drama.  Rather, it is emotional because we are all human beings who thrive on creating emotional connections.  This is why stories – when told persuasively – can be so powerful.

According to Wortmann, “One of the things we say in business school that drives our students crazy is that people will not work to understand your message.”  Instead, you have to work to be understood.  For example, a sales trailer is to a business as a movie trailer is to a feature film.  In both cases, we struggle to have our message understood because people have accumulated knowledge.

Wortmann helps entrepreneurs create their sales trailer, which acts as a hook that prompts the potential client to ask questions.  Whatever way you send the message – whether spoken, written, e-mailed, tweeted or otherwise transmitted – always err on the side of conciseness.  An e-mail, for example, should be three or four lines — maximum.

The same philosophy of brevity should apply to any presentation, which Wortmann believes in limiting to a single word per slide.  He shares that same affinity with Silicon Valley venture capitalist Guy Kawasaki and the late Steve Jobs.

To listen to Craig Wortmann’s full interview on the art of the sale, click here.

Is It Time to Reform the Fee-for-Service Model?

September 25th, 2012

Despite the healthcare industry’s attempts to alter the way in which physician reimbursements are determined,  fee-for-service is still the accepted basis for payment.  Typically, physicians are reimbursed according to the number of patients they see and how many procedures and tests they order.  Policymakers have concluded that the “do more, earn more” business model is deeply flawed and one reason why Americans pay so much for healthcare.  In 2012, Americans will pay more than $8,000 per individual on healthcare.  That’s more than double the $3,400 average spent for each person in other industrialized nations.  What’s more, all that spending has not made Americans healthier.

The time may have come to find a new reimbursement model that places less of a financial burden on patients while still rewarding physicians.  An August article in the Journal of the American Medical Association notes that the fee-for-service payment is the foundation of even some emerging accountable-care organizations, including Medicare’s popular shared-savings program, say Drs. Allan Goroll of Harvard University Medical School and Stephen Schoenbaum of the Josiah Macy, Jr., Foundation.  The shared-savings program “Promotes accountability for a patient population and coordinates items and services under (Medicare) Part A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery.”

Goroll and Schoenbaum isolate a number of reasons for why fee-for-service endures:  many physicians are risk-averse and so resist change; additionally, skepticism is a “major barrier” to reforming the payment model.  “Transitioning to a new payment system will require new modes of practice, and many physicians feel ill equipped to assume financial or performance risks individually or even collectively,” Goroll and Schoenbaum write.  “The concern is that continued reliance on fee-for-service payment for primary care as well as for specialists, with its emphasis on volume of services, threatens meaningful practice transformation and the very goals of delivery system reform.” The bottom line is that the healthcare industry must develop “robust, scientifically validated risk-adjustment models,” according to Goroll and Schoenbaum.  Payment reform could blend capitation and fee-for-service with a plan to revise the payments over time.

Change must be forced on the medical community, whether or not they are ready for it.  One provision of the Patient Protection and Affordable Care Act (ACA) requires alterations to payment and delivery systems to control costs and enhance the quality of care.  Rather than basing payment solely on the number of patients a physician sees and tests ordered, these methods promote preventive care and maintain open lines of communication between a patient’s multiple physicians.

The potential alternative reimbursement models presently being considered include:

•       Bundled payments or fixed amounts paid to healthcare providers for related services a patient needs within a given timeframe.

•       Patient-centered medical homes.  This model would restructure primary-care practices so that their focus is on preventive medicine, patient education and healthcare coordination.

•       Accountable care organizations, in which physicians and other providers share responsibility for providing cost-effective, quality care for patient groups.

Big Medicine Is Watching You

September 24th, 2012

Big Medicine is on the way, according to celebrated author and Harvard professor, Atul Gawande, In a major article in the New Yorker, Gawande describes the new frontier of ICUs as ones where patients may be monitored not from a telemetry station within the hospital but from a remote command center filled with high-tech screens and armies of highly-trained technicians that could be miles away and serve multiple hospitals.

Gawande cites the example of Dr. Armin Ernst, who is responsible for Steward Health Care’s ICU operations at the system’s 10 hospitals, serving approximately 8,000 patients annually.  “He sees it (the ICU) as the temporary home of the sickest, most fragile people, Gawande writes.  ”Nowhere in healthcare do we expend more resources.  Although fewer than one in 4,000 Americans are in intensive care at any given time, they account for four percent of healthcare costs.  Ernst believes that his job is to make sure that everyone is collaborating to provide the most effective and least wasteful care possible.”

Ernst’s ICU command center is a one-story building that contains millions worth of technology, banks of computer screens carrying cardiac-monitor readings, imaging scans, and lab results.  Special software sends an alert when it detects patterns that raise concerns.  Doctors and nurses operate consoles where high-definition video cameras zoom into any ICU room and talk directly to the staff or to the patients themselves.  Soon, the tele-ICU team will monitor the care for every ICU patient in the Steward system.

The experience was eye-opening for Gawande.  After five minutes of observation, I realized that the remote ICU team wasn’t exactly in command; it was in negotiation, Gawande writes.  Sometimes the bedside staff resist resolving problems that the E-ICU staff identify.  You have got to be careful from patient to patient, Gerard Hayes, a tele-ICU doctor, explained.  Pushing hard has ramifications for how it goes with a lot of patients. You don’t want to sour whole teams on the tele-ICU.  Several hospitals have decommissioned their systems; clinicians have placed gowns over the camera, or torn the camera out of the wall.

Despite some opposition, there is good reason why hospitals are adopting the E-ICU model.  Remote monitoring is a high-tech solution to a sticky problem facing hospitals: how to care for the sickest patients amid a worsening shortage of intensive-care physicians.  Currently, only one third of ICU patients receive care from an intensivist.  The Department of Health and Human Services believes that demand for intensivists will outstrip supply over the next 30 years.  Initial results from the E-ICUs have been dramatic: Mortality rates are 30 to 40 percent lower when physicians provide 24/7 care to prevent complications and minimize errors. A University of Massachusetts Medical Center study of 6,400 patients in seven adult intensive-care units monitored by E-ICU showed substantial benefits in reducing both costs and mortality, according to the hospital’s director, Craig Lilly.  The hospital saved $5,000 per case, mostly because the system lets intensivists in the remote-command center “detect instability and bring new treatment to the patient before they would have received it in a typical ICU.”

GOP VP Candidate Paul Ryan Advocates “Medicare Premium Support”

September 5th, 2012

Now that Representative Paul Ryan (R-WI) has been selected by former Governor Mitt Romney (R-MA) as his vice presidential running mate, the debate is focusing on the Wisconsin representative’s plan to reform Medicare.  Known as Medicare Premium Support, it “refers to a system under which Medicare enrollees would pick from a menu of competing plans with a fixed government payment to help defray premium costs.  Enrollees would be on the hook for any charges above the government contribution.  But they could save money by selecting a plan with a premium below the federal subsidy.”

Ryan says that under his plan, the government’s contribution toward premiums will equal the cost of the second least expensive plan in any market — or traditional Medicare — whichever costs less.  Ryan believes that his plan is politically feasible because it doesn’t begin until 2022 with the result that it retains traditional Medicare for Americans who were 55 and older in 2011 — meaning that baby boomers are exempt from the changes.  Democrats who oppose the plan contend that Ryan’s Medicare overhaul would subject seniors to the vagaries of the private market, leaving them with little protection against rising premiums and negligible benefits.

So what is the difference between the Democratic and Republican cuts to Medicare?  The ACA stresses government control and central planning. The law creates a panel of 15 unelected government officials, called the Independent Payment Advisory Board (IPAB) to direct changes that will shrink spending by cutting physician and hospital reimbursement.  The Wyden-Ryan plan preserves the ACA’s targets for future Medicare spending, but uses competitive bidding.  Seniors would have the same benefits that they do now, and would have the option of choosing from several government-approved private insurance plans.

The Republican budget targets Medicare growth of GDP plus 0.5 percent, just as the 2013 Obama budget does. The difference lies in the fact that the GOP budget repeals the ACA, while maintaining that law’s Medicare cuts.  The Democratic budget leaves the ACA in place.

Writing in the Washington Post, Ezra Klein puts the difference in a nutshell:  “The difference between the two campaigns is not in how much they cut Medicare, but in how they cut Medicare.”

In an exclusive interview with Modern Healthcare magazine, Ryan says that “This is an idea whose time has come.  And it’s a bipartisan idea.  What Representative Ron Wyden (D-OR) and I tried to do was to plant the seeds of a bipartisan consensus.  We knew we weren’t going to pass it because of the politics.  We did this together to get the consensus-building started.”  Ryan believes that the plan’s chances for approval will greatly improve in 2013 — especially if the Romney/Ryan team wins the November 6 presidential election.  “I’m actually pretty optimistic,” he said, noting that the United States should reform healthcare on its own terms and “fix this on our terms” instead of borrowing European ideas.  “We believe there are far superior ways to get back to a patient-centered healthcare system, the nucleus of which is the patient and doctor — and not the government,” Ryan said.  “We believe consumer-driven, market-based reforms do more to alter the cost curve of healthcare inflation.”

If Ryan’s plan is enacted into law, people 55 and younger would see a change from one in which everyone gets the same set of government-paid benefits to one in which the government gives all senior citizens a fixed amount of money.  They could use this to purchase private insurance or pay a portion of the cost of enrolling in traditional Medicare.  Ryan has not said how much the premium support payment would be.  But he would limit the annual growth rate to no more than one-half percent more than the economy’s overall growth rate, even though healthcare costs are rising at a significantly faster pace.  Ryan’s plan would also raise the Medicare eligibility age to 67 from 65 by 2034.

Not so fast,” Democrats warn as partisans from both parties accuse the other side of throwing senior citizens under the bus.  “Make no mistake about it — these Republicans don’t believe in Medicare,” Obama campaign senior adviser David Axelrod said.  “They want to turn it into a voucher program.  And slowly, all the burden is going to shift to seniors themselves.  And that is not an answer to entitlement reform.”

Republicans counter that $716 billion in cuts to Medicare are already a part of the Patient Protection and Affordable Care Act (ACA).  An online video created by the Republican National Committee features Ryan saying that Democrats “have refused to make difficult decision because they are more worried about their next election than they are about the next generation.”  According to Ryan, “We won’t duck the tough issues; we will lead.”

Uwe Reinhardt, a healthcare economist at Princeton University disagrees, saying that rather than motivating insurers to control their costs, the Ryan plan will not benefit seniors.  “You’re essentially shoving these guys out on a boat, saying, ‘We’ll give you a push, but if the waves are rough, you’re on your own,” he said.  “It would really worry me if I were a middle-class American.”

Burnout Affects 30 Percent of Nurses

August 29th, 2012

With hospitals slashing costs to cope with growing financial pressures, nurses believe that the resulting insufficient staffing is detrimental to patients.  A team from the University of Pennsylvania has identified a key reason for this: Hospitals where relative fewer caregivers work typically provide inferior care.  If hospitals reduced their proportion of burned-out nurses to 10 percent from the prevailing 30 percent, they would prevent 4,160 cases a year of the two most-common hospital-acquired infections and save $41 million in Pennsylvania alone.  “It is costing hospitals more money not to spend money on nursing,” said Linda H. Aiken, one of the study’s authors and director of the Penn Nursing School’s Center for Health Outcomes and Policy Research.

The researchers determined that the nurses studied averaged 5.7 patients on a typical shift, said Rutgers University professor Jeannie Cimiotti.  “Maybe they are staffed a little bit above what they should, but if they (hospitals) can provide an organizational climate that’s conducive to nursing, I think they’d be fine,” Cimiotti said. “That doesn’t mean you can overburden them because workload is one of those factors that does contribute to burnout.”

“Most burnout is related to high workload,” said Patricia Eakin, an ER nurse who is president of the Pennsylvania Association of Staff Nurses and Allied Professionals.  Patients nowadays need a whole lot of care. There’s a lot of equipment, a whole lot of fancy things. A lot of things that take a lot of time and a lot of attention.”

Historically, the number of nurses per patient was low following World War I.  At what would ultimately become Baylor University Medical Center, the hospital in 1919 accommodated 225 patients who were cared for by a nursing staff of 12 graduates and 100 students.  As recently as the 1980s, nurses often cared for eight or nine patients (Insert Nurse Together link here.)  The night shift could see a single nurse caring for as many as a dozen patients, often without a Certified Nursing Assistant (CNA) to assist.

The shift in the United States from Florence Nightingale’s concept of multi-bed wards (which often contained 30 or more beds and were typically staffed by one or two nurses) to private and semi-private rooms started in the years following World War II and was mostly complete by the 1970s.  Private hospital rooms at this time were primarily reserved for patients whose families could afford to pay extra to keep their relative out of a ward and hire a private duty nurse to provide one-on-one care.  According to Jean C. Whelan, PhD, RN, “Private-duty nursing was the employment of nurses by individual patients for the delivery of care.  Patients hired their own nurse, who cared for them either in their homes or in the hospital.  Patients paid the nurse for her services with cash, based on a predetermined fee.  The nurse, generally employed for the duration of an illness, cared for only one patient at a time.  In essence, the private-duty nurse delivered highly individualized care to paying patients for as long as a patient needed and could pay for the nurse’s services.”

According to a U.S. National Library of Medicine of the National Institutes of Health Study, thousands of nurses – the vast majority of them women — migrate each year in search of better pay and working conditions, career mobility, professional development, a better quality of life, personal safety, or sometimes just novelty and adventure.  The percentage of foreign-educated physicians working in Australia, Canada, the United Kingdom, and the United States is currently reported to be between 21 and 33 percent, while foreign-educated nurses represent five to 10 percent of these countries’ nurse workforce.”

In 1994, nine percent of total registered nurses were foreign-born RNs; by 2008 that percentage had risen to 16.3 percent, or about 400,000 RNs.  Of those, approximately 10 percent had immigrated to the U.S. during the previous five years. About one-third of growth in RNs between 2001 and 2008 was fueled by foreign-born RNs.  The news is not all positive, though.  According to Newsweek, “While pay has risen in some regions to attract more nurses, in recent years it has flattened at the national level.  That’s why up to 500,000 registered nurses are choosing not to practice their profession — fully one-fifth of the current RN workforce of 2.5 million.”

Bringing those badly needed nurses from overseas is not always easy, said William R. Moore of El Centro Regional Medical Center in California, who has been waiting two years for 20 nurses from the Philippines he recruited to obtain visas.  In the meantime, Moore can’t find talent in the area.  “We’re in the poorest and least literate county in California, right in the middle of the desert,” says Moore. “We’re not a destination for (American) nurses.”

As the role of registered nurses has evolved over the years to encompass increased responsibility, so too, have the educational requirements.  A two-year associate degree (AND) or a four years bachelor’s degree — typically a Bachelor of Science in Nursing (BSN) — are the two primary degrees required in the 21st century.  Many nurses opt to pursue their Master of Science in Nursing (MSN) degree, which requires a minimal commitment of two years to complete the course work.  Others go even further in their educations, studying for a Doctor of Philosophy (PhD) or a Doctor of Nursing Practice (DNP).

Studying for a BSN degree – like all college educations – doesn’t come cheaply.  According to the Registered Nurse Education Requirements website, “Tuition and clinical fees together make up the total cost of nursing education while the tuition fee for a two-year nursing course in a community college is just $1,400, the clinical fees can are considerably higher at $4,000 plus per semester.  For a bachelors course the students end up paying almost $7,000 to $8,000 in clinical fees while the tuition is still lower at just $2,000 to $3,000 per semester.  Apart from this, students will also have to incur the cost of books, parking, basic living expenses and housing in case of out-of-town colleges. The cost of training at hospital affiliated nursing schools can be higher at $55,000 for resident student and over $100,000 for non-residents.”

Is End-of-Life Care Worthwhile?

August 27th, 2012

Even in the age of advanced healthcare directives and living wills, Americans still must cope with a dilemma when it comes to end-of-life healthcare for themselves or their loved ones.  Consider the fact that Medicare pays as much as $55 billion annually for physician and hospital bills during the last two months of patients’ lives.  That’s more than the budget for the Department of Homeland Security, or the Department of Education.  Estimates are that 20 to 30 percent of these medical expenses usually have no meaningful impact.  The federal government pays for a majority of the bills with no questions asked.  Medicare spends nearly 30 percent of its budget on beneficiaries in their final year of life.

Given this information, the question is whether extending someone’s life is worth the money it can potentially cost.  The solution potentially could have been a snap for Congress when it passed the Patient Protection and Affordable Care Act (ACA).  Unfortunately, the previously bipartisan issue quickly became a political hot potato.

According to Dr. Ira Byock, it costs as much as $10,000 a day to maintain someone in the intensive-care unit, even if the patient remains there for weeks or even months.  “This is the way so many Americans die. Something like 18 to 20 percent of Americans spend their last days in an ICU,” Byock said.  This discussion raises the philosophical issue of the value of human life.   According to Byock, “While many people question spending a lot of money to prolong the life of an elderly, frail patient, it was perfectly logical for a frail person to value life extension as much as a perfectly healthy person.  With advances in medical care, it can be argued that the value of hope has been increasing along with the statistical odds of staying alive until a cure is found.”

Over-treatment, according to Byock, is an unfortunate side effect of medical advances.   “We have enormous scientific prowess and remarkable diagnostic and treatment,” so that when you are admitted to the hospital, the system “moves you quickly towards the next diagnosis and then the next diagnosis after that for the next component problem in a whole picture that few people will see.  It’s a dysfunctional system that feels like a conveyor belt.  We have a disease-treatment system rather than a healthcare system caring for human beings.”  Byock notes that the same system can lead doctors and patients to regard any reduction in treatment, or even accepting that patients are going to eventually die, as failure.  There are amazing ways to combat disease and extend life.  “That’s all well and good.  The problem is, we have yet to make even one person immortal,” Byock concluded.

Dana Goldman, director of the Schaeffer Center for Health Policy and Economics at the University of Southern California and founding editor of the Forum for Health Economics and Policy, has a difference approach.  According to Goldman, “We think of healthcare as an expense, but we really should be thinking of healthcare as an investment.  We want to invest where we have the greatest return. I would put prevention in that bucket.  But the way we do it now, no one has an incentive to invest in things with a long-term return.”

PTSD Can Last a Lifetime

August 14th, 2012

Picture this: Late at night, in the middle of winter, a 69-year-old woman, less than 5 feet tall, flees her north suburban home, carrying two shopping bags filled with her belongings. When found wandering by police, she insists that someone is trying to kill her. 

The woman in question is Sonia Reich (mother of Chicago Tribune jazz critic Howard Reich), who is the subject of “Prisoner of Her Past,” a documentary from Kartemquin Films, renowned for “Hoop Dreams.” Sonia, who managed to hide from the Nazis as a young girl in the woods outside a small Polish village (now a part of Ukraine) has been diagnosed with late-onset post-traumatic stress disorder (the same PTSD which we normally associate with army veterans). Prisoner of Her Past, directed by Gordon Quinn, deals with the type of PTSD which appears years, or even decades after the trauma occurs. Moreover, the extent of Sonia’s PTSD is so great that not only is she suffering from the usual symptoms (sleeplessness and hypervigilance among others) but that she also, as her son writes, “had so deeply absorbed her childhood traumas into the fabric of her being that there simply was no way she could ever escape them…they were replaying themselves in an endless loop in her traumatized psyche.”

PTSD is something we need to think about seriously as we deal with the aftermath of traumatic events like the recent mass shootings in Colorado and Wisconsin and the return of servicemen and women from Iraq and Afghanistan. It is estimated that one in five soldiers suffers from PTSD or major depression. Brian Scott Ostrom is one of them. He was the subject of a 2012 Pulitzer Prize-winning essay in the Denver Post.  After serving four years as a reconnaissance marine and deploying twice to Iraq, he has struggled with daily life, from finding and keeping employment to maintaining healthy relationships. But most of all, five years later, he’s struggled to overcome his brutal and haunting memories of Iraq.

PTSD Awareness Day was first established by Congress in 2010 after Sen. Kent Conrad, (D-N.D.), proposed honoring North Dakota Army National Guard Staff Sgt. Joe Biel, who took his own life following two tours in Iraq. Biel’s birthday was June 27. “National PTSD Awareness Day should serve as an opportunity for all of us to listen and learn about post-traumatic stress and let all our troops — past and present — know it’s okay to come forward and ask for help,” Conrad said in a statement.

Secretary of Defense Leon Panetta called the recent surge in the number of military suicides “troubling and tragic” at a suicide prevention conference sponsored by the departments of Defense and Veterans Affairs in Washington last week. 

There were 154 suicides among active-duty troops in the first 155 days of the year, according to a recent report from the Associated Press, a number that is 50 percent higher than the number of U.S. forces killed in action in Afghanistan over that time period. It is the highest rate in 10 years of war. Panetta also said he wants to make the Department of Defense a “game-changing innovator” on research in areas related to suicide prevention, including in post-traumatic stress and traumatic brain injury.

Do Olympic Athletes Risk Permanent Injury?

August 13th, 2012

Those of us joining the more than 3 billion people around the world in Olympics watching, may find one part of the experience uncomfortable and even withering – the sight of healthy men and women and boys and girls risking life and limb for a laurel wreath. There was German weightlifter, Matthias Steiner, dropping a 432-pound barbell on his neck;. South Korean weightlifter Jaehyouk Sa, dislocating his right elbow while trying to push his lifts up to 357 lbs; and American sprinter, Manteo Mitchell, running 200m in the 4×400-meter relay preliminaries with a broken leg.

Now, the experts have stepped up to calm the concerns of the audience. It is a time of extremes, but scientific evidence suggests no-one will push beyond the limit. “You’ll never die because of intensity of exercise,” said Gregoire Millet, director of the Sport Science Institute at the University of Lausanne in Switzerland. “You will never die because you push yourself so hard.”

Enter The Governor

Research, much of it led by Tim Noakes, a professor of exercise and sports science at the University of Cape Town in South Africa, suggests that however much some athletes may want to push beyond all previous performances, a switch in the brain – known as the “central governor” – will keep them safe. “The brain uses the symptoms of fatigue as key regulators to ensure that the exercise is completed before harm develops,” Noakes wrote in a recent paper in the journal Frontiers In Physiology. For Richard Budgett, chief medical officer at the London 2012 Games, having the “central governor” around is a good thing. Himself a former Olympic gold-medal winning rower, Budgett is also eager to point out that many myths about potentially negative health effects of many years of hard exercise are generally not borne out by the scientific evidence. Studies in weightlifters, for example – who many might suspect would suffer lower back pain and damage as they get older – show that these athletes actually have less back pain in later life than other people. A scientific paper published in 1997 on the health status of former elite athletes from Finland found those who focused on aerobic sports in particular had long, healthy life expectancy and low risk of heart disease and diabetes in later years.

What About Accidents?

Of course, what the mavens aren’t addressing are the accidents along the way to Olympic glory: In March of 2010, Courtney King-Dye, 33, an Olympic dressage rider heading to Beijing, fell on her head, suffering a traumatic brain injury. She was in a coma for a month. Four years later, King-Dye says, “I’m still a definite fall risk, can’t walk without my cane, can’t brush my hair or teeth or eat with Righty (her right hand) and now I talk like a 5 year old instead of a 3 year old.”  And weightlifter, Jaehyouk Sa’s career may be cut short by his injury.

Take it to the Limit

There has been some scholarship recently about what the human body can bear as we see athletes routinely break records because they are fitter, stronger and faster. A recent article in the New Yorker used the spectacle of the World’s Strongest Man competition to opine on whether the athletic arms race has gone too far.

As an example, Brian Shaw, one of the sport’s superstars has deadlifted more than a thousand pounds; pressed a nearly quarter-ton log above his head; harnessed himself to fire engines, Mack trucks, and a Lockheed C-130 transport plane and dragged them hundreds of yards. To be fair, this is hardly comparable to the Olympics since these competitions don’t regulate drug and steroid use and so put their athletes at much greater risk. In 1977, one of the leaders in the early rounds was Franco Columbu, a former Mr. Olympia from Sardinia who weighed only a hundred and eighty-two pounds. Columbu might have gone on to win, had the next event not been the Refrigerator Race. This involved strapping a four-hundred-pound appliance, weighted with lead shot, onto your back and scuttling across a parking lot. Within a few yards, Columbu’s left leg crumpled beneath him. All the ligaments were torn, and the calf muscle,the hamstring, and the front patella sustained enormous damage. The injury required seven hours of surgery and threatened to cripple Columbu for life (he later settled a lawsuit against the World’s Strongest Man for eight hundred thousand dollars.)

In the end, we need safety more than we need glory and we commend the legions of regulatory bodies and coaches who take the safety of their athletes seriously.