TIME Military

Navy Nurse Refuses Gitmo Force Feed Order

Guantanamo Hunger Strike
In this photo Nov. 20, 2013 file photo reviewed by the U.S. military, a U.S. Navy nurse stands next to a chair with restraints, used for force-feeding, and a tray displaying nutritional shakes, a tube for feeding through the nose, and lubricants, including a jar of olive oil, during a tour of the detainee hospital at Guantanamo Bay Naval Base in Cuba. Charles Dharapak—AP

A detainee described the act as a conscientious objection

A Navy medical officer at the U.S. military prison at Guantánamo Bay, Cuba has refused an order to continue force-feeding hunger-striking prisoners in what one detainee lawyer described as an act of conscientious objection.

“There was a recent instance of a medical provider not willing to carry-out the enteral feeding of a detainee. The matter is in the hands of the individual’s leadership,” a Pentagon spokesperson said in an email. “The service member has been temporarily assigned to alternate duties with no impact to medical support operations.”

It is the first known instance of a U.S. service member rebelling against the Pentagon’s force-feeding policy. An unknown number of the 149 detainees at Guantánamo’s Camp Delta have been on hunger strike for the past year and a half to protest their indefinite detention.

News of the refusal comes to the public by way of an attorney for one of the detainees, who, according to The Miami Herald, says his client described how some time before the Fourth of July a Navy medical nurse suddenly shifted course and refused to continue force-feeding prisoners. The nurse, he said, was abruptly removed from duty at the detention center. The attorney said his client described the nurse’s action as a conscientious objection.

The Herald reports that the prisoner who provided news of the incident described the nurse as a roughly 40-year-old Latino man most likely with the rank of lieutenant in the Navy.

Last year, civilian doctors writing for the New England Journal of Medicine declared that medical professionals taking part in force-feeding was unethical and called the Guantánamo medical staff to refuse to participate.

TIME Books

Read to Your Baby, Say Doctors — But Which Books?

Baby Reading
Tetra Images / Jamie Grill / Getty Images

The American Academy of Pediatrics is urging members to encourage reading to newborns

When her son was very small, Dr. Pamela High noticed something funny: she would come home and find the babysitter in the rocking chair with the boy, reading out loud from whatever book she happened to be working on herself at that moment. As her son got older and began to respond more to the words themselves, the babysitter switched to reading children’s books — but the image made an impression on his mother.

Now her son is grown up and High is the lead author of a new policy paper released by the American Academy of Pediatrics that recommends pediatricians advise parents to read aloud to young children “beginning in infancy,” to encourage word learning, literacy and positive family relationships. The report notes that reading to children is correlated with family income level — and, as the New York Times reports, Scholastic is donating 500,000 books to the literacy advocacy group Reach Out and Read, which works with pediatricians to get books to low-income families — but even in families that make 400% of the poverty threshold only 60% of children are read to daily.

But what exactly should they be reading? If your one-day-old baby doesn’t understand the words, does it even matter?

“I don’t think that there’s a huge amount of information on that,” High tells TIME, noting that her own experience with the sitter reading to her son is just an anecdote, not research. “The research is primarily about reading children’s books.”

Part of the issue is that it’s hard to measure understanding, to say that at some number of months of age it begins to be important that you’re not reading a kid something totally inappropriate like 50 Shades of Grey. Language is acquired gradually, and High says that she’s personally seen evidence of understanding even before the 1-year marker at which most children can point to pictures that correspond with spoken words. Plus, she says, “I think [babies] understand the emotion in the words that are being read to them very, very early.”

But there are some things that parents should keep in mind, she says. For example, it’s developmentally appropriate for children to chew on books, so you shouldn’t read to a baby from a valuable and rare manuscript. Colorful illustrations can help keep a child’s attention, but even so you shouldn’t expect a very young infant to concentrate on the book for longer than about 90 seconds. And finally, it’s important that the parent not think the book is annoying. “It starts with the parent’s enjoyment and then becomes a shared enjoyment,” High says.

With that in mind — chewability, enjoyability and calm or positive emotions — here are a few books parents might consider reading aloud to their newborns:

For actual newborns: Can’t & Won’t by Lydia Davis. This short story collection, which came out in April, is a book for grown-ups, by Man Booker International Prize- and MacArthur grant-winner Davis. But it’s great for tiny babies because the short stories are, in some cases, very short. If your kid doesn’t understand the words yet and you can only sneak in a minute of reading a day, and it’s perhaps a minute out of the precious few moments of “me time” you have, you can get up to date on a buzz-worthy literary release. Plus, if the baby’s too young to do too much damage to the book, investing in a hardcover isn’t such a risk.

For slightly older babies who will one day get English degrees: Shakespeare’s Sonnets. Because emotion is more important than content, a nice big collection of lovey-dovey poems that take about a minute to read is perfect. As High points out, reading is often used to help a baby wind down at the end of the day, and the regular rhythm of a rhyming sonnet can’t hurt. If the baby can’t understand Shakespearean words, that’s no big deal; if a word or two does sneak into her brain, there’s nothing inappropriate to worry about.

For kids old enough to touch the book: Farm by James Brown. This picture book made the 2014 Best Books for Babies list, an annual list put together by the Carnegie Library of Pittsburgh, the Pittsburgh Association for the Education of Young Children and the Fred Rogers Company (as in, Mr. Fred Rogers). The selection committee commended the author for his use of interesting textures to “add tactile appeal” to the book.

For kids who are already growing up too fast: The Poky Little Puppy by Janette Sebring Lowrey. The classic tale of a lollygagging dog was once ranked by Publishers Weekly as the top-selling children’s book ever, having sold nearly 15 million hardcover copies between 1942 and 2000. That means parents are likely to remember reading it themselves. Help your infant’s future literacy and reminisce about your own childhood, all in one place.

For kids old enough to laugh : Toot! by Leslie Patricelli. Yes, this book is about farts — but it was also, just today, named Amazon’s top book of the year so far for babies age 0–2.

MONEY Health Care

The Mystery Behind Your Doctor’s Charges, Unveiled

Illustration of man unlocking filing cabinet of doctors
Medicare is providing consumers with a new way to research health care pricing. Paul Blow

A quick peek into some Medicare data can help you reduce your medical bills. Here's how to use the new tool.

Medicare has pulled back the veil on what doctors, physician assistants, physical therapists, and other health care providers charge, letting everyone see the rates for a wide variety of procedures in advance for the first time. “This is a big step forward and will be very enlightening,” says Jean Mitchell, a health economist at Georgetown University.

Health care researchers and fraud investigators are salivating over the data—already it’s revealed that some doctors favor the most expensive in-office intravenous drug treatments, likely because Medicare pays them a percentage of the cost, says ­Gerard Anderson, a professor at Johns Hopkins University.

As a patient, you can use the numbers, which are from 2012, to conduct your own research into prices and practices. Even if you’re under 65, you can glean valuable insights. Head to the Medicare Physician and Other Supplier Look-Up Tool to find your doctor. You’ll see how many times he or she did a particular service and the average charges. Then here’s what to make of the information:

If you’re facing surgery
See how often your doctor operates; for complicated procedures, frequency pays. “Research shows doctors who perform more than 50 hip replacements a year have fewer complications,” says Andrew Fitch of Nerdwallet Health. Yet about half of orthopedic surgeons did fewer than 20 a year on traditional Medicare patients, a Nerdwallet analysis of the data found.

The tally excludes operations on patients with private insurance or a Medicare Advantage Plan. Still, a low number compared to other MDs should prompt you to ask how often your doctor does the job, particularly for hip and knee replacements, says Fitch. If the figure is high, keep in mind that at times every physician in a group practice bills under one name.

If you’re on traditional Medicare
For a price preview, calculate the difference between the “average Medicare allowed amount” and the “average Medicare payment.” That’s your share of the bill before supplemental insurance kicks in. One caveat: What you see in the Medicare database are charges per service. So ask if you’ll face other bills or a facility fee if you’re cared for at a hospital or surgical center.

If you have private insurance
Check out the “average submitted charge,” which is the doctor’s full retail price. If you go outside your network, you’ll owe the difference between this amount and what your insurer deems a “customary and reasonable” rate (get that from your insurer), on top of your co-insurance.

You should negotiate with out-of-network docs, and the Medicare allowed amount is a good starting point. If the provider balks at that, go as high as 35% more, which is the national standard for a reasonable charge, says Anderson.

TIME Cancer

What Doctors Should Say When Patients Want a Miracle

Hospital patient
Getty Images

A new tool teaches doctors how to talk to patients about miracles

Many doctors, when delivering difficult news, have heard sick patients say they’re hoping for a miracle. That conversation can be difficult for physicians, whose careers are grounded in science—but who are also in the business of saving lives. While “miracles” may seem a silly thing to wish for, a 2008 study, 57% of randomly surveyed adults said they believed God’s intervention could save a family member even if physicians declared treatment futile.

In order to help doctors navigate this common situation, a team of physicians at Johns Hopkins Kimmel Cancer Center have created a helpful conversational tool called AMEN (affirm, meet, educate, no matter what), recently published in the Journal of Oncology Practice. AMEN is meant to teach doctors an alternative to either challenging the patient’s beliefs, remaining silent or changing the subject when conversations take a turn. Instead, it gives physicians a tool to affirm hope while keeping intact their role as the provider of accurate medical information. Here’s what it stands for:

  • Affirm the patient’s belief. Validate his or her position: “Ms X, I am hopeful, too.”
  • Meet the patient or family member where they are: “I join you in hoping (or praying) for a miracle.”
  • Educate from your role as a medical provider: “And I want to speak to you about some medical issues.”
  • No matter what, assure the patient and family you are committed to them: “No matter what happens, I will be with you every step of the way.”

“I use the AMEN mnemonic pretty much every day. Maybe my patients need more miracles than other doctors’ patients, but it is a common occurrence and an underlying theme in many people’s lives,” says Dr. Thomas Smith, the director of palliative medicine at Johns Hopkins.

“The heart of the AMEN protocol is the commitment to joining rather than placing more distance between patient and provider,” the authors write.

They recommend that when patients say they are hoping for a miracle, doctors say something along the lines of “It is God’s role to bring the miracle, and it is my role as your physician (or nurse) to bring you some important information that may help us in our decision making.”

Restoring and maintaining hope, the authors say, is one of their responsibilities—and learning how to navigate that is critical to patient-doctor relationships.

 

MONEY Health Care

Rx Relief: How to Save Up to 80% on Prescription Drugs

Five strategies to help you leave the pharmacy without having to swallow a bitter pill.

The average American filled 12 prescriptions last year, according to the IMS Institute for Healthcare Informatics, and as a result the pharmaceutical industry grossed $329 billion. (You’re welcome, Pfizer.)

Minimize your pain at the pharmacy counter by taking these steps when your next script is written:

1. Use coupons. For expensive prescriptions, you can save 50% or more this way. There are a lot of ways to get your hands on prescription coupons, but start by asking your pharmacist. Call ahead or ask at the counter; the pharmacist may have some on hand or be able to tell you where to find them—most likely online. If you want to search yourself, try the drug company’s website first, then check the website of your pharmacy.

2. Try mail order. Mail-order pharmacies save you money by skipping the bricks-and-mortar middleman and sending the drug directly to you, typically in 90-day quantities. Your health insurer may work with a specific mail-order house, and often you’ll get better pricing by going this route. Alternately, your prescribing doctor’s office may have a preferred pharmacy they work with regularly, so inquire when the prescription is written.

3. Ask your doctor about pill splitting Most drugs come in more than one dosage, but aren’t priced on the same scale as the dosages. This means that, per milligram, higher dosages of the same drug are often cheaper—and you could save money by purchasing double doses of your prescriptions and halving them. Not every drug should be split, so consult with your doctor first. If you’re given the go-ahead, make sure to purchase a pill splitter from a drug store to ensure consistent and equal dosing.

4. Opt for generics If there’s a generic version of your brand-name drug available and you’re not taking it, you could be wasting a lot of money—on average, generics are 80% to 85% cheaper than their brand-name counterparts. Contrary to the myth that generic drugs are held to different standards than brand-name drugs, there is no significant difference between them. Generic drugs are allowed to differ from brand-name drugs only insofar as appearance and inactive ingredients. By law, medication dose, safety, quality and instructions must be the same. Stores have gotten into price wars over generic drugs: Target now charges $4 for hundreds of medicines, for example, and Meijer and Publix are among those that offer some drugs gratis, which is why you may want to…

5. Compare pharmacies. Drug prices can vary widely between pharmacies, even locally, so you may want to shop around before simply going to the nearest drug store. Websites like GoodRx and LowestMed compare pharmacies within zip codes for specific medications, and even offer coupons and drug information. You may be surprised to find that some drugs vary by $50 or more for the same supply and dosage. In that case, the cost of convenience may just be too high.

 

More stories from NerdWallet Health:

So You’re Pregnant? Here’s What You Need to Know About Your Maternity Coverage and Benefits

How to Save On Asthma Medications

Patient Advocates: Your New Best Friend for Managing Your Health Care Experience

TIME health

Now Doctors Can Use Google Glass to Record Your Visits

Google Glass Prescriptions
John Minchillo—AP

Google's face-computer may be coming soon to a doctor's office near you

Doctors, nurses and other medical professionals are about to get a new tool in the medicine bags: Google Glass.

Drchrono, a digital health startup, claims to have created the first “wearable heath record” that can be accessed through Google’s futuristic face-computer. Doctors can use the app to store patients’ records as well as record medical visits and even procedures via Glass’ camera for consulting later on.

While some patients may be hesitant to let doctors record their visits, Drchrono says its Glass application complies with HIPPA standards which protect patient privacy — and patients will have to give permission to have doctors record their visits via Google Glass.

The application is currently in its beta phase, though Reuters reports about 300 physicians have signed up to use it. Drchrono, just one of a plethora of startups tapping into the healthcare app market, has also developed digital health records apps for iPads and smartphones.

 

TIME Doctor

My Doctor, the Concierge

Patients who pay an extra $5,000 a year can reach the doctor via office phone and email, but their return call is from the support staff. Patients who pay $10,000 per year may also reach the doctor via texting, Skype, Facetime and Google Hangout, and feedback is from the doctor, who will also make house calls. Getty Images

Forget the Hippocratic oath--welcome to a world of Gold and Platinum patients

It’s not like I’ve never been dumped before. Still, I was ill prepared to be dumped by my GP. For 12 years I thought we got along O.K. Now I continually ask myself, “Was I not sick enough for her?”

The first warning sign was the single-serve coffee machine in the waiting room, featuring festive flavored international coffees and chai.

I eyed it nervously. Had there been an article in an AMA journal offering hints on transforming your drab, predictable reception area into an upscale medi-café? At my next Pap smear, would I meet a barista and be offered a selection of croissants?

“No, no,” I said to myself. “Current wisdom dictates that when her practice becomes successful, she must personalize her brand.”

If this were a movie, the tone of the music cues would begin to get darker as we arrived at the day the glass display cases containing lovingly arranged bottles of moisturizer were installed. “I guess pricey moisturizers are considered medicine now,” I rationalized, wondering about the ever more porous boundaries between beauty and health.

The music cues would grow darker yet as we cut to a scene where I had the flu and found myself waiting for an appointment, surrounded by pamphlets for “facial fillers” and “injectables” like Juvéderm. If she writes me a prescription for a spray tan, I am going to walk, I thought.

But I remained loyal. She was my doctor. Her office still called to remind me about getting my checkups. She was entitled to branch out.

Then, about a month ago, I got The Letter.

“I’d like to wish you and your family a happy holiday season and a prosperous new year,” it began.

Interesting word choice, I thought. Prosperous rather than healthy.

Her reasoning became clearer as the letter went on to explain that we were all being dropped as patients–unless we paid a $5,000- or $10,000-a-year retainer for her services, depending on the plan.

“Our nation is faced with the most difficult time in the history of our health care system,” the letter went on. “As a result, I will now be transitioning my practice to a concierge medical service.”

Concierge? Another interesting word choice. Defined in the dictionary as “a member of a hotel staff in charge of special services such as arranging for theater tickets or tours. A porter. A doorman. A janitor.” Did my doctor now offer restaurant recommendations and tickets to The Lion King?

The letter explained that there would still be a charge for medical visits and that patients would still need health insurance. But the new annual fees would entitle us to a variety of rock-star privileges like “Direct access to the doctor, 24/7.”

As it turned out, the doctor was offering a two-tiered plan with levels designated Gold and Platinum. In Gold, her patients could reach her only via office phone and email. But for an extra $5,000 a year, Platinum patients’ options widened to include texting, Skype, Facetime and Google Hangout.

I admit I was impressed that someone had figured out how to monetize Google Hangout.

There were other differences between the two plans. Platinums got house calls, 20% off on Botox, a complimentary session with a fitness trainer and “prompt telephone feedback with test results by [the doctor] herself.”

Presumably the Golds, with only $5,000 extra to spend, would be called by whoever–whenever they got around to it.

Both plans, however, were eligible for “fast and easy prescription renewals” and “a dedicated support staff.” All of which I seem to recall were always an expected part of going to a regular doctor. The letter contained no information regarding the availability of complimentary lollipops.

In its new capacity as a concierge service, my doctor’s website claims, her practice will traverse a medical high wire reaching from “congestive heart failure” to “muffin top.”

It’s all making me rather nostalgic for the good old days of 2012–when I naively assumed doctors took the Hippocratic oath seriously. That oath ends, “May I long experience the joy of healing those who seek my help.”

If this concierge trend continues, perhaps they’ll update it to include “and for an extra $10,000, I will LIKE your rash on my fan page.”

Markoe won multiple Emmy Awards as a writer for Late Night With David Letterman. Her most recent book is Cool, Calm & Contentious.

MONEY Health Care

5 Things to Do by Year-End

Want to better protect your health and wealth as we head into the New Year? Try taking these five steps.

1. See a doctor if you’ve met your deductible …

The average deductible has nearly doubled since 2006, reaching $1,135 in 2013, reports the Kaiser Family Foundation.
If you’ve hit yours this year or you’re close, schedule elective procedures ASAP, while your insurer will pick up most of the tab. If not, push off appointments until 2014, when the costs can be applied to your presumably even larger deductible.

“It’s smart to consider what your health needs are,” says Tracy Watts, senior partner at Mercer.

2. … or a dentist if you are below the max

Dental plans typically pay out no more than $1,500 to $2,000 a year, according to the National Association of Dental Plans — a limit you can easily blow through when you’re facing any kind of serious work, like a root canal, crowns, or a full-mouth deep cleaning. So you want to space out appointments to get the most from your coverage.

Do what you can this year to reach your 2013 maximum, then go back in January or February to work on next year’s cap.

3. Don’t give up on tax breaks

Starting in 2013, medical expenses must exceed 10% of your adjusted gross income before you can write them off against your federal taxes, up from 7.5% last year.

Think you won’t qualify? Don’t toss those receipts just yet. Some states have lower thresholds — New Jersey’s is 2%, Alabama’s is 4%, and Massachusetts’ is 7.5%. And for those 65 and older, the federal threshold stays at 7.5% through 2016, notes Brian Haile, senior vice president for health policy at Jackson Hewitt.

4. Grab your wellness rewards at work

At more than a quarter of large firms, employees can earn gift cards, trips, stuff, or a few hundred dollars in cash by participating in wellness programs, such as screenings that measure your weight and cholesterol or questionnaires about your health habits, and those rewards run out at year-end. (A smaller number reward you by adding to a health savings or health reimbursement account.)

Now’s the time to see if you can nab some easy cash, says Watts.

5. Check your FSA

Health flexible spending accounts have been use-it-or-lose-it. Unless your boss gave you until March 15 to spend the money (about half of big firms do, reports WageWorks), you forfeited what was left on Dec. 31.

In October the Treasury Department revised the rules to let you carry over $500, but only if you don’t get the grace period and your company changes the plan in time. Since you can put $2,500 into your FSA, you could have a balance to spend now.

MONEY Health Care

5 Things to Know About Electronic Health Records

Electronic medical records should not be subject to prying by employers or insurers. illustration: Gillian Blease

More doctors and hospitals are switching from paper to electronic medical records as part of a government-initiated effort to manage patient care more effectively.

1. Chances are you have one — or will soon.

Get ready for your doctor’s office or hospital system to switch your medical record from a stack of papers to a computer file.

More than half of physicians have started keeping electronic medical records, the federal government announced this year. About 80% of hospitals have gone digital, too, with urban institutions leading the way.

Driving adoption: In 2015, clinicians’ Medicare payments will drop at least one percentage point each year that such records aren’t in place.

2. They can improve your health — and protect your wallet.

Electronic records, while not a cure-all, can help cut problems such as duplicate tests and prescription errors, says Michael Painter, a health policy advocate at the Robert Wood Johnson Foundation.

Electronic prescription forms, for example, can guard against incorrect dosages and harmful interactions with other medications. A preventable drug error during a hospital stay, one study found, added an average $8,750 in costs.

3. You’ll get a look too.

Pushed by the feds, hospitals with advanced systems will roll out online portals by October (some have already), making it easy for you to see your file. Clinicians begin in January. So start asking providers whether they have records you can view.

Potential benefits: catching mistakes and easily pulling lab results to show a specialist in another hospital network.

4. They can create new problems.

Electronic records aren’t immune to mistakes. Studies show that dropdown menus in record systems make it easy for physicians to introduce authoritative-looking errors.

Also, patients reading their doctor’s notes could be tempted to research their condition and improperly self-medicate, says Nancy Davenport-Ennis of the Patient Advocate Foundation, or suffer “undue stress” from a mention of minor abnormalities in lab results.

5. Privacy is still an issue.

Digitization doesn’t make it more likely that employers or insurers will pry, since their access rules haven’t changed. Just read release forms to see how your data might be used.

Snooping by hospital personnel, though, can be a problem; some facilities don’t have systems for checking that, says Steven Stack, a doctor and expert in health information technology. Hackers are a threat too; look up major data breaches here.

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser