Longer looks: Pittsburgh's 'frayed safety net'; feeding hungry kids in the summer; curing cancer

Aug 1 2014

Every week KHN reporter Marissa Evans finds interesting reads from around the Web.

Pittsburgh Post-Gazette: Poor Health: A Frayed Safety Net
More than a quarter of the hospitals in the Pittsburgh area closed in the first decade of the 21s century, drastically reducing the amount of charitable care available to the poor. The failure of the remaining hospitals to provide adequate care to low-income patients and the inability of free and government-funded clinics to fill the gap has left the region's health safety net badly frayed. ... "Everyone knows you go broke providing health care to broke people," said Braddock Mayor John Fetterman, whose community lost its hospital in 2010. Broke people usually have no insurance or they are on Medicaid. Hospitals and doctors lose money serving such patients. ... In Pittsburgh, St. Francis Central, St. Francis Medical Center and Mercy Providence -; all Catholic institutions now closed -; once were routinely among the largest providers of uncompensated care in the region. ... "The problem as always was money," said Sister Ann Carville, who was vice chair of St. Francis Health System when UPMC bought and then tore down St. Francis Medical Center in Lawrenceville. "We really lived by the principle that we wouldn't turn anyone away, and we didn't" (Sean D. Hamill, July 2014).

PBS NewsHour: Why Summer Is The Hungriest Season For Some U.S. Kids
Now that Isaac Mejia has graduated first grade, he knows a little something about the grading scale. And he's developed his own set of evaluations for the summer camp he attends here in D.C. For example, watching movies: super fun. Swim time: pretty good. Eating broccoli at lunch: worst "by far." "Sometimes I just spit it out in the trash can," he said. "But sometimes I'll swallow it." That's better than never, his camp counselors at Park View Recreation Center say. Even Isaac's small bites of healthy food are more than many of his neighbors eat in the summertime. Because when school ends each year, so do the free and reduced-price meals that most low-income D.C. families rely upon for basic nutrition (Jason Kane, 7/16).

JAMA Internal Medicine: The Many Stories Of My Mother's Death
I knew immediately on hearing the details of the accident that my mother could not, would not, survive her injuries. ... My mother had severe osteoporosis. The seat belt crushed her ribs, and the air bag shattered her neck. ... I knew she would die. I just wondered when, and how. ... Each day at work as a palliative medicine physician I advocate vigorously for patients near the end of life. Yet even when my mother entered the recognizable death spiral known as the "Weissman triad" (feeding tube, restraints, pulse oximeter), I could not summon up the courage to challenge her physicians' authority. I wanted to cry out: "Do you not recognize that your best medical technology cannot rescue her tired and broken body?" Instead, I said nothing. Why did I remain silent? The lesson I have gleaned from my own mother's death is this: our standard approach to end-of-life decision-making places an enormous and unfair burden on patients and families. The standard approach is to first elicit from patients and families their preferences, finding out what they want. But my mother was frequently delirious. My father was so grief-stricken he could barely speak. And I was not about to say, "My preference is that my mother dies." Nor was I willing to ask my mother, "Do you want to die?" (Dr. Paul B. Bascom, 7/28).

WBUR: My Right Breast: One Man's Tale Of Lump And Mammogram
It began with an itch I just had to scratch. Doesn't every adventure begin that way? I was lying in bed reading on a Saturday evening, and without even looking I idly scratched a spot on the right side of my chest –- at that point I had a chest, not breasts. As I did, my fingers rode over a small something, a little like a speed bump about an inch below and two inches to the left of my right nipple. I stopped reading and started poking. And prodding. And pushing. And feeling. And manipulating. And panicking (B.D. Colen, 7/25).

The Atlantic: What If The Path To Curing Cancer Has Been Part Of The Body All Along?
For generations the three pillars of cancer treatment have been surgery, radiation, and chemotherapy. But both chemotherapy and radiation are crude weapons with significant collateral damage to healthy tissue, and surgery can leave cancerous cells behind. Scientists have long tried to understand how to get the immune system-;the body's natural defense mechanism-;to recognize cancer cells as the enemy and destroy them. And now we may finally be turning the corner: Doctors are finding that clinical regimens known as immunotherapies can empower a patients immune system to fight the disease like it might an infection, while sparing a person's normal cells (Jacoba Urist, 7/28).

Mashable: Big Data's Effect On Organ Transplant Wait Lists
Of 28,594 organs transplanted in 2013, you haven't heard about most. The stories of a few might go viral thanks to social media, but the vast majority of donated organs are harvested from deceased donors or taken from living donors in relative obscurity. While the total number of organs transplanted seems like an impressive amount, nearly 18 people still die each day waiting for a new organ, according to the United Network for Organ Sharing, the private, non-profit organization that manages the U.S.'s organ transplant system under a contract with the federal government. Faced with more than 120,000 people who need a life-saving organ and a constant shortage of donors, economists, doctors and mathematicians are teaming up with data to save lives (Eli Epstein, 7/23).