Posted by on August 13, 2013 - 10:33am

New research is surfacing that links anesthesia to inhibited cognitive developments in children under four. Significant brain development occurs in young children at this time, and ketamine—a common anesthetic—has been shown to affect the brain’s learning ability. Studies began back in 2003 when Merle Paule, Ph.D., director of the Division of Neurotoxicology at the FDA’s National Center for Toxicological Research, began observing the effects of ketamine on young rhesus monkeys, since this species closely resembles humans in physiology and behavior. While the ketamine-exposed monkeys performed cognitive experiments less accurately than the control group, the affect of ketamine on human children requires further research.

Interest in this area grew so much that, in 2010, the FDA and the International Anesthesia Research Society founded an initiative called Strategies for Mitigating Anesthesia-Related neuroToxicity in Tots, or “SmartTots” for short.  Director of Anesthesia, Analgesia and Addiction Products at FDA, Bob Rappaport, M.D. said, “Our hope is that research funded through SmartTots will help us design the safest anesthetic regimens possible.” SmartTots continues to advocate for research that can protect the millions of children who receive anesthesia each year.

Supplemental studies are necessary to understand whether all forms of anesthetics elicit similar deficits as ketamine, and, if so, how long these deficits last. Columbia University and the University of Iowa are currently exploring the effects of anesthesia on infant brain development and cognitive and language ability, thanks to the funding from SmartTots.  Until more conclusive data is published, parents are urged to work closely with their child’s clinicians in weighing all options and risks before exposing young children to anesthesia.

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Posted by on April 6, 2013 - 11:51am

Two weeks ago for Forbes I wrote about some of the unintended, but positive, consequences that could result from employers dropping employer-sponsored health insurance (ESI). Following that post, many weighed in about various other consequences of such behavior from employers and what that means for health care coverage for millions of families in the US. One issue in particular caught my attention; not only because of the touching stories associated with the discussion, but because of the unique and inspiring methods some providers are utilizing to compensate for the lack of insurance coverage.

As Jodi Carroll of VoteFacts.org underscored, millions of women in the United States are reliant on their significant other,s employer to provide their family’s health insurance. Women, in particular, are disproportionately reliant on husband’s employers for coverage, with children who are also dependents.

Although positives will most likely develop in the individual market due to ESI transitions, the current and near future are exceptionally frightening for many women as employers have started down that slippery slope by excluding many dependents from future insurance coverage.

Given the recent discussion in the media, spouses and children being dropped from employer coverage is a growing concern. In the context of a bloated and dysfunctional health care system, this significant and immediate alteration in health insurance coverage could be very difficult for many households to absorb financially, particularly if their income falls just above the threshold for federal subsidies to purchase policies in the upcoming health insurance exchanges.

But, what if these mothers and children had an option that could provide them with most of the services they need, and was easily accessible and affordable.

Throughout the nation, in response to shifts in health care, many small direct health care providers are opening shop. These direct providers are able to combat many concerns through price transparency, easy access and lower costs as they establish what is basically a menu of cash only services. Further, these one-on-one scenarios improve decision-making between patient and physician and take out the need for insurance and proof of citizenship.

While many services are not available through these direct providers, a bulk of what the majority of people need are. Chronic disease management, acute care services and preventative care are all available at a face value, affordable price.

Residents in North Carolina, for example, have embraced a shining example of this new system. Access HealthCare is a direct care provider in NC with results to be impressed by. One of their diabetic female patients, and her teenage son, had lost their health insurance when her husband them, taking his ESI with him. According to her KevinMD website interview, she was working two retail jobs to fund her diabetes treatment and medical, at a cost of $5,000 a year.

However, once she found Access Healthcare, her annual costs were reduced to $450 annually and her health care results improved.

Similarly, according to Dr. Brian Forrest, founder of Access Healthcare, “a patient who normally has an 80/20 plan (like Medicare Part B) might end up having to pay 20% of their fee to see a specialist for a stress echo. If the cardiologist I use gives them an 85% discount to just pay cash up front, then the patient actually spends less out of pocket by not using their insurance.”

Although not all medical care can be preventative or primary, Dr. Forrest contends that “only about 1% of the population gets hospitalized annually. Only about 5-10% of patients that seek care at a physician office cannot get the services they need in the outpatient setting.”

For now, most of what women and children need can be found in offices like those mentioned above. However, I would still encourage citizens to purchase, at minimum, catastrophic coverage for hospitalization.