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September/October 2007

Volume 67 | Issue 5

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Showdown Over Children’s Health

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September/October 2007 AMA Alliance Today �

September/October 2007 Volume 67 Issue 5

OUR MISSIONThe mission of the American Medical Association Alliance, Inc. is to partner with physicians to promote the good health of America and to support the family of medicine. As the organization’s member magazine, AMA Alliance Today is committed to providing readers with the news and information most relevant to today’s medical families.

We welcome your suggestions, concerns and ideas. Please send all submissions to:

AMA Alliance TodayAMA Alliance515 N. State St., 9th FloorChicago, IL 60610Phone: �12.464.4470Fax: �12.464.5020E-mail: [email protected]

EXECUTIVE DIRECTORJo Posselt

EDITORRosetta Gervasi

MANAGING EDITORLeia Vincent

Senior EditorJennifer West

Contributing WriterMelissa Walthers

ADVISORY BOARDDianne Fenyk – PresidentSandi Frost – President-ElectNancy Kyler – SecretaryCarolyn Plested – TreasurerNita Maddox – Immediate Past President

Design and Layout Anna Matras

AMA Alliance Today (ISSN 1088-7�9�) is published six times per year by the American Medical Association Alliance, Inc., 515 N. State St., Chicago, IL 60610. The subscription price per year for members of the AMA Alliance is $�.50, included in annual membership dues. The subscription price for non-members is $7 in the United States and U.S. Possessions, $10 in all other countries. A single copy is $2.50. Printed in the U.S. Change of address may be made by sending old address (as it appears on your AMA Alliance Today) and new address with ZIP code. Allow six weeks for changeover. POSTMASTER: Send address changes to AMA Alliance Today, American Medical Association Alliance, 515 N. State St., Chicago, IL 60610.

© Copyright 2007 by the American Medical Association Alliance, Inc.

6 SCHIP: Showdown Over Children’s Health

11 Watch What You Say!

1�Growing with Our Children: Health Promotions Committee Updates Activity Books

15 Understanding Nutrition Labels

16 Changing the World One Volunteer at a Time

4

5

From our Alliance family to yours

Editorial

18 County Alliance News

19 State Alliance News

10 Health Report

12 Issues Watch

9 Screen Out! News

regular columns and departments

features

on the cover


4 AMA Alliance Today September/October 2007

My husband and I both celebrated birthdays this summer. Nothing unusual about that, except that these were “health-insurance-rate-increase” birthdays. Every five years our insurance company raises premium rates based on our ages. This time, the premium for each of us went up $215.93 a month, or $5182.32 a year for the two of us! Fortunately, my husband’s practice pays our health insurance, but since he’s in solo practice, this over-head expense increase is a significant bump-up for his small business.

This increase makes me wonder and worry about the millions of Americans who can’t afford even the basic health care that my family enjoys. We all know that the uninsured and underinsured often go without health care–or sink so deeply into debt that they never recover.

I became even more acutely aware of America’s health care crisis in August: I was privileged to be a reviewer for the AMA Foundation Fund for Better Health grant appli-cations. My area of assignment was Uninsured/Underinsured. There were 28 applications from around the country–every one of them deserving. Most of the applicant’s programs serve those who are barely above the “200-percent-above-the-federal-poverty-level” that demarcates eligibility for some form of medical assistance. Grant applications included requests for free clinics, free prescription programs, an EKG machine, dental equipment, interpreters, patient advocacy and education materials and workshops–an endless list of health care needs. Applications came from small rural communities, large urban cities and medium-sized towns, and were submitted by medical school student and resident groups, religious-affiliated health care programs, social agencies, counties, cities, Alliances and medical societies.

On August 23, the AMA launched its new “Voice for the Uninsured” campaign. This three-year, multi-million-dollar campaign is intended to spur action to create coverage for the uninsured. The goal of the campaign is to position the AMA as the preeminent leader working to solve America’s health care coverage crisis. It will be directed at presidential candidates as well as members of Congress. It is timed to coincide with the 2008 presidential campaign–presidential candidates and legislators will be encouraged to incorporate AMA’s plans to cover the uninsured—and will have milestone dates that correspond with the key primary and general election dates.

The Alliance is a natural partner with AMA and by virtue of our membership in the “family of medicine,” we must speak up for those uninsured citizens who are cared for around the country by Alliance members, physician spouses, medical students and resi-dents. In fact, Alliance members already worked side by side with AMA representatives at the Iowa State Fair on August 16, passing out literature about the campaign, soliciting signatures for a petition and listening to fair-goers share stories about being uninsured.

Across America, Alliance members work regularly to improve the health of our communities. It’s not only appropriate, but natural and timely that Alliance members now also become vocal advocates for those who have no health care safety net.

I hope you’ll join me by adding your voice to this pressing issue.

Dianne Fenyk AMA Alliance President [email protected]: For additional coverage on the Alliance’s participation at the Iowa State Fair, see page 19, and for more on AMA’s “Voice for the Uninsured” campaign, visit the Web site at www.VoiceForTheUninsured.org.

President’s Letter

From Our Alliance Family to Yours


I worked at my last full-time job for 17 years, and as you can imagine, during all that time one accumulates a lot of stuff—both literal and figurative. The literal stuff is easy enough to sort and pack. But the figurative paraphernalia—the beliefs, assumptions, habits and rituals—are another matter. Take the rituals for instance.

We held our annual meeting for members in a different city each year—a hectic, boisterous extravaganza of business meetings, seminars, workshops and social events—and one of the ways some of us prepared ourselves mentally to interact with the 1,500 or so of our members who attended the meetings was by taking time out at the beginning of the week for a relaxing manicure and pedicure.

Another ritual that sprang up during my time at the associa-tion was the marathon holiday party. You wouldn’t think that a holiday celebration would seem like a chore, but I’m not an avid party-goer, and the executive director who was in place for most of those years, was verbose and liked to expound at great length at these festivities, typically ensuring that we were trapped in our seats for an almost four-hour meal. Yet, as nearly as I can recall, hardly anyone chose to opt out of the lunches. The incentive was that our generous annual bonus checks were distributed at the end of that party, and since the timing of the event was usually just before the last shopping weekend of the season, few of us could resist the opportunity to make one last holiday shopping junket fortified with free food and fresh funds.

The last year I was there, I had planned to leave the organi-zation at the same time that we broke for the holidays, but our executive director at the time (not the loquacious one) had made it clear that if I didn’t want a goodbye ceremony, it was incumbent on me to attend the holiday festivities, so he could say a few words of farewell.

Despite my misgivings, as the day of the event approached, I actually started to look forward to it, thinking it would be nice to say goodbye to people who had been an integral part of my life for so long, and by the day of the party, I was ready to enjoy the festivities. I had even bought myself a cheerful holiday jacket made out of red quilted fabric.

No matter where we were going, I knew I would be able to find something to eat regardless of the menu. I was more concerned about the seating. After all, when you know you’ll be relegated to your chair for almost four hours, you pray for a well-padded underpinning. And it helps if the tables are not set too closely together. All that hitting elbows with your tablemates and scraping your chair into the table behind you can be trying.

I don’t remember the name of dining establishment, but it seemed to be a middle-of-the-road choice, not too formal and not overly casual. I was happy to note, as we made our way through the busy holiday crowd, that we had been given our own private dining room on the lower level of the building. When we got there, I was even happier to see that the tables were set in a very leisurely arrangemenced far

apart and with only five or six chairs to a table. Choosing an item off the menu was wonderfully simplified too as lunch was a well-stocked buffet. The chairs themselves were service-able restaurant ware, but well padded and seemingly adequate for a four-hour ordeal. I was also touched to see that the restaurant had tried to make the room festive with a decorated tree, wreaths on the wall and flickering lighted votives to enhance the table being used as a makeshift bar.

At these events, we didn’t usually sit together by department, opting to mix and match for greater variety. At my table, I happened to be sitting with two Linda’s, an Elizabeth and a LaQuetia. As conversations do at these types of functions, the talk jumped around from topic to topic until we landed on the subject of idioms and how the expression for intoxication differs from region to region. Elizabeth, a recent transplant from China, mostly kept quiet due to her self-perceived disadvantage understanding American colloquialisms, but the rest of the group was animated.

Linda #1 offered the opinion that in her culture, “you’re drunk” is designated by the expression “you’re lit up,” while I explained that in my experience, “you’re lit up” means “you seem like you’re in a very good mood today,” or “you seem unusually animated.” We continued in this fashion for a time and Linda #2 was mentioning how the expression was inter-preted in her neck of the woods just as I got up to make my way to the decorated bar for a soft drink. I ordered a ginger ale and the bar tender poured it in a small tumbler and, at the last minute, added a slice of lime as a garnish.

I meandered back to my seat, stopping along the way to exchange pleasantries with some of my co-workers at other tables, only to find when I got back that the conversation was still on vernaculars. I was planning to attempt to steer the conversation to a new topic so Elizabeth could join in, when Linda #1 jumped up from her seat, pointed to me and said in an agitated voice, “Rosetta, you’re lit! You’re all lit up!” In the meantime, Elizabeth had pushed her chair back from the table and was also pointing at me, delivering an incompress-ible barrage of words I took to be her native tongue. At this point, I was not really nonplused, not so much taken aback as angry, and launched into an interior monologue with myself: “What with the drink glass and the lime, they must think this is an alcoholic drink. But so what? Even though I don’t usually imbibe, I’m well over the age of consent and if I want to have scotch or vodka, I will. And why are Elizabeth and Linda so upset. Surely, my taking a drink, even if they assume that’s what it is, is no reason for that reaction.”

I was trying to decide how to make all these points a bit more diplomatically aloud than I was reciting them to myself when I felt a distinctly warm sensation traveling up my body. “Now what?” I thought. An early hot flash? A reaction to the disproportionate reaction to the possibility that I might be having a drink? At just about the same time, I saw a flash of light half way to the floor on my left side and looked down to investigate the source. There I discovered a line

You’re All Lit Up—Do Something! | By Rosetta Gervasi

Editorial

July/August 2007 AMA Alliance Today 5

continued on page 10



Agreeing to provide basic health care for poor children seems like it would be a slam dunk—a noncontroversial issue that no one would have reason to oppose.

Plus, it seems like it would be political suicide to do so. Look at the statistics: The popular State Children’s Health Insurance Program (SCHIP) has been in place for 10 years and has earned a reputation for efficiency and success. In some states, a single visit to a hospital emergency room, typically the health care of last resort for the uninsured, can cost society almost as much as covering kids for a full year through the program.

SCHIP was established in 1997 by Congress as a means to cover children in families that earn too much to qualify for Medicaid, but too little to buy private insurance. The program is funded jointly by states and the federal government, with about 70 percent picked up by the latter. The program will end September �0 unless it is reauthorized by Congress.

In the past decade, the program has provided care for millions of children and reduced the number of uninsured significantly. This is good news all around because as reported by the St. Louis Post-Dispatch on August 2�, children who have regular access to care stay healthier, miss fewer days of school and are more likely to get regular exercise.

Currently, about 6.6 million children are covered through SCHIP, and of the estimated nine million still without health insurance, between five and six million are eligible for the program.

And Americans—voting Americans—support it by a healthy margin. According to a recent University of Michigan report, nearly two out of three adults support it for children in families with incomes as high as $48,500, or �00 percent of the federal poverty level (FPL). In addition, a Wall Street Journal Online/Harris Interactive poll conducted August 16-20, 2007, found that 58 percent of U.S. adults, including half of all Republicans, agree that expanding the program is a good idea. And another poll released August 24, found that nine of 10 registered voters (86 percent) said they would support reauthorizing SCHIP, and 6� percent said they would extend SCHIP’s budget by an additional $�5 billion.

What’s the Problem? So, what is the problem? Just who is opposing this effective, successful program and why? The New York Times article pub-lished July 8 crystallized the debate: “The seemingly uncontrover-sial goal of insuring more children has become the focus of an ideological battle between the White House and Congress. The fight epitomizes fundamental disagreement over the future of the nation’s health care system and role of government.” And the Congressional Record writing on July 2�, predicted that the confronta-tion between SCHIP proponents and opponents “could evolve into one of the big domestic policy debates of the Bush era.”

There you have it. Proponents see it as a simple matter of providing care to the millions of children who are still without it. Opponents, including the White House, see it as a back-door maneuver toward a government-sponsored, single-payer health care system. In fact, the August 2� St. Louis Post-Dispatch article quotes the president commenting about SCHIP: “I wouldn’t call it a plot, just a strategy to get more people to be part of a federalization of health care.”

According to a Los Angeles Times article from June 28, Bush also said that Democrats want to “take incremental steps down a path toward government-run healthcare for every American— a wrong path for our nation.” He added that it would “eliminate choice and competition in healthcare, cause huge increases in government spending that could lead to higher taxes, and result in rationing, inefficiency and long waiting lines.”

Notwithstanding the President’s comments, Newsday reported on August 2�, that for most children covered by SCHIP, the program pays for care delivered by private plans. Nevertheless, to give Bush

Showdown Over Children’s Health

SCHIP:

*Editor’s Note: As we go to press on September 25, a SCHIP reauthorization bill has not been approved by Congress and sent to the president yet, but there is an expected Congressional agreement to add $�5 billion to the program, to be paid for by a 61-cent increase in federal taxes on tobacco. However, the agreement does not include physician payment relief, which AMA and nearly 150 state and national specialty advocacy groups had urged lawmakers to address.

In the meantime, in a move that is reportedly angering Democrats and Republicans alike, President Bush continues to warn that he will veto the bill when it arrives on his desk. The Chicago Tribune reported today that the President “abruptly called a news conference to strike back against Democratic assertions the he is indifferent to children’s health needs,” insisting that he intends to veto the bill because it’s beyond the scope of the program and “is a step toward federal-ization of health care.”

By Rosetta GeRvasi


September/October 2007 AMA Alliance Today 7

his due, the program has already grown beyond the scope of Congress’ original intent in establishing it in 1997. Robert Novak writing in the Chicago Sun-Times on June 28, noted that originally the program was passed at an outlay of $4 billion per year, and that its “faults” have largely been overlooked. “The federal government consistently granted waivers to permit 14 states to cover adults under SCHIP, which now costs $5 billion a year,” wrote Novak. He also noted that in Minnesota, 92 percent of money spent under the program goes to adults.

How Did We Get Here? Just how did a program that was clearly earmarked to provide basic health coverage for the nation’s needy children go on to become the centerpiece of a contentious legislative and policy debate? A decade ago, when Congress established the program, the legislative body gave states some discretion in deciding which populations to cover, and over the years, several states have expanded the program to cover children in middle-income families as well as some adults.

The Bush administration complains that many states have distorted the original intent of the program by raising the eligibility limit to as high as �50 percent of the FPL. That’s true. States began expanding the SCHIP’s income requirements to include more children from families with higher incomes. Currently, 19 states and the District of Columbia provide health insurance to children in families with incomes more than 250 percent of the FPL or are in the process of doing so. Missouri covers children in families earning up to three times the FPL, and Illinois covers all children with a combination of programs, including SCHIP. However, in both Missouri and Illinois, families earning more than twice the FPL have to pay premiums to enroll children. At least 10 states have adopted or are considering proposals from families that earn up to three times the FPL, and some states like New Jersey and New York are seeking federal approval to go to 400 percent (that’s a household income of $82,600 for a family of four.)

Bush and Republican legislators warn that the coverage expan-sion not only goes beyond the original intent of Congress, but might serve as an incentive for families with private coverage to drop it and enroll their children in SCHIP due to the lower costs. In fact, one study reported in the New York Times on August 22, found that 14 percent of enrollees did just that.

Another bone of contention in the debate over the future of SCHIP is that more controversial legislation is being tacked onto the reauthorization and expansion bills. For instance, the bill approved by the House of Representatives just before their August break would also prevent Medicare physician cuts for t he next two years, according to American Medical News. The Children’s Health and Medicare Protection Act of 2007 (CHAMP), passed by the House on August 1, would turn the 9.9 percent and 5 percent Medicare payment reductions expect-ed in 2008 and 2009 into 0.5 percent increase for each year. The bill also includes provisions of $50 billion over 10 years to help Medicare beneficiaries in the form of payments to Medicare

Advantage plans, and extends a number of rural health provisions, which are set to expire.

Administrative Maneuverings While Congress debates the future of the children’s program with nary a glance at the President’s agenda, the administration is fighting back. In late August, Newsday reported that according to the Congressional Budget

Office, President Bush first pushed a funding increase so small that it would have made it impossible to continue covering all existing beneficiaries. That proposal was ignored by Congress, so in August, the administration announced rules that would impose additional costs on beneficiaries and establish hurdles for states that want to expand the pool of eligible children that qualify for the program.

The new rules, outlined in a letter from Dennis G. Smith, director of the federal Centers for Medicaid and State Opera-tions, to state health officials on August 17, make it nearly impossible to comply, say state officials. They are taking issue with the letter not only for its content, but also for its timing. According to an August 21 New York Times piece, the letter was sent during a month-long Congressional recess, and on a Friday, a traditional dead zone for media coverage.

Under the new requirements, children must be without insurance for a year before they can be enrolled, and families of children in the program must pay fees comparable to those paid by families with private insurance. In addition, states must show that they have enrolled at least 95 percent of children below 200 percent of the FPL and that the number of children insured through private companies has not dropped more than two percentage points over five years. The letter spells out a list of restrictions that would stop any SCHIP expansions and force states to change their rules to comply with the federal order. The 95 percent threshold is considered especially onerous as no state has yet met it or is likely to do so anytime soon. The letter also stated that the steps outlined must be implemented within a year.

In interviews following the issue of the new rules, administration officials said the changes were intended to return SCHIP to its original focus on low-income children and to make sure the program did not become a substitute for private health insurance, according to the August New York Times article.

At least 18 states would be forced to scale back or abandon planned expansion of their SCHIP plans as a result of the new rules, accord-ing to a New York Times article published August 22. States are preparing written responses calling for revisions to the new rules, and failing that, will work to alter or sidestep the rules by passing legislation, according to the report. In addition, senators from both sides of the aisle are threatening to block the new regulation, according to the August 24 issue of Congressional Quarterly.

The San Francisco Chronicle article on August 2�, speculates that the reason for the administration’s rules is that Congress could probably override a presidential veto of the SCHIP reauthoriza-tion. The President has said repeatedly that he will veto any reauthorization bill that attempts to expand the program beyond its original intent.

Opponents, including the White House, see it as a back-

door maneuver toward a government-sponsored, single-

payer health care system.



What Happens Now? As the administration proceeds to define the future of SCHIP by rule, Congress is proceeding with a legislative solution. Following on the heels of the House passage of CHAMP, the Senate passed its own reauthorization and expansion bill, the Children’s Health Insurance Program Reauthorization Act of 2007, with 18 Republi-can senators voting for it in defiance of the President’s threats to veto. The Senate bill doesn’t provide for a physician pay fix but passed by a wide margin—substantially more than enough to override a veto.

Both the House and Senate versions of the reauthorization legislation continue SCHIP for five years, the House with a price tag of $50 billion and the Senate calling on $�5 billion for the program, both allowing enrollment of chil-dren from higher-income families. The House bill would provide enough funding to almost double the number of children covered to about 11 million, while the Senate version could add about three million children. Both the House and Senate bill rely on steep increases to federal taxes on tobacco products to fund the expansion—61 cents in the Senate version and 45 cents in the House bill.

When Congress reconvenes in September, a House-Senate conference committee will try to reconcile the differences to produce a compromise bill to send to the President for signature.

In the meantime, since SCHIP is due to expire at the end of September, plans are also in the works to deal with the program on an interim basis.

A law signed on May 25 will provide $650 million in federal funds to fill budget shortfalls in SCHIP in 2007. The money will be divided among 14 states that expected to run out of SCHIP money before September �0, the end of the fiscal year.

Those hefty increases in the federal tobacco taxes, which might prove contentious details for a Congressional conference committee to work out due to concerns from legislators that are from tobacco-growing states, are precisely what makes the proposed legislation so attractive to the American Medical Association (AMA) and the AMA Alliance.

Where We Stand On August 17, the Alliance issued a statement commending Congress for passing legislation “to ensure the future health of our children.” In part, the statement, attributable to Alliance President Dianne C. Fenyk, noted that, “As spouses of physicians, our number one priority is family—protecting the health and welfare of the most vulnerable in our society…Moreover, we are pleased that the proposed legislation would serve as a deterrent to smoking and is aligned with our nationwide anti-smoking Screen Out! program… a step in the right direction toward a smoke-free America.”

And Sandi Frost, the Alliance’s president-elect explains what makes using tobacco taxes to provide health care to children ideal:

“It seems a natural to me—reduce the devastating effect of tobacco on our children while at the same time using the revenue from those harmful products to do some good—protecting our children’s future.

“I saw an article recently that said higher cigarette prices and consequently lower legal cigarette purchases accounted for a 19 percent decline in smoking in New York City. Think of the positive outcomes if those numbers were multiplied across the country.”

Senator Gordon Smith (R-Ore.) who originally proposed the 61-cent increase would seem to agree. He told USA Today on July 11 that, “It really does seem to come down to a choice

between children and tobacco. This is a two-fer. It does decrease smoking and it does connect public health care costs with one of the drivers of that cost...”

That position is backed by the research. Data from the American Cancer Society Action Network show that for every 10 percent increase in the price of cigarettes, there is a corresponding seven percent drop in youth smoking rates and a four percent decline in adult smoking.

AMA agrees that using tobacco taxes to fund SCHIP is a “win-win” proposal. In a statement issued on August � and attribut-able to association President Rob Davis, M.D., AMA said of the tobacco tax propos-

als: “Kids in low-income families get the health care they need, and it’s paid for with an increase in federal tobacco taxes that can help deter current and future Americans from using tobacco.”

As a member of the Health Care Coverage Coalition for the Uninsured, AMA supports full SCHIP funding to cover all eligible children and advocates using the tobacco tax increases proposed to cover the expansion, according to AMNews. At AMA’s annual meeting in June, delegates approved an AMA policy calling for reauthorization of SCHIP before it expires at the end of Septem-ber, and also called for a commitment from Congress of more than $60 billion over five years to fund it.

Indeed, AMA’s endorsement of the program’s expansion is offered by some as an assurance that the program is not a start down a slippery slope of a government-sponsored health care delivery system. Rep. Lloyd Dogget (D-Texas) commented in the New York Times on August 2 that, “The Republicans silly claims of socialized medicine are belied by the [House SCHIP reauthoriza-tion] bill’s endorsement by the American Medical Association.”

Next Steps Reauthorization and some level of expansion for SCHIP is not a matter of real debate. It’s considered a forgone conclusion. What does remain to be seen, however, is the scope of the expansion and what will happen if Bush follows through on his threats to veto any bill that expands the program beyond the fiscally conservative limits he has outlined.

How, rather than if, the SCHIP reauthorization issue is resolved could be a harbinger of how the long-awaited Congressional debate over the future of American health care will ultimately play out.

The seemingly uncontroversial goal of insuring more children has become the focus of an

ideological battle between the White House and Congress.

The fight epitomizes fundamental disagreement over the future of the nation’s health care system

and role of government.


In the NewsAs many of you have seen and heard, smoking in movies has become a national issue garnering major announcements from studios in the past month. Disney Co. announced that it would phase out images of smoking in some of their fi lms, although we are urging members to write letters to Disney asking that they create a mandatory “R’” rating policy for smoking imagery in all of their fi lms. The Screen Out! section of the Alliance’s Web site has op-ed contributions from members about the Disney announcement and letters available to send to the studio regarding their policy. Julie Freeman of Alabama had an article published in the Montgomery Advertiser outlining the Alliance’s stance on the issue. Thanks to members like her, the Alliance and the Screen Out! campaign continue to draw national attention through letters to the editor.

Training OpportunityThe Alliance’s Screen Out! campaign is off ering a new opportunity for East Coast members to get involved in the campaign by holding a one-day regional conference. The day-long workshop will be held at AMA’s Washington, D.C. offi ce on November 3, 2007. All members are welcome to attend this free training event, which aims to educate and motivate Alliance members to join the commitment to the Screen Out! campaign, while also increasing membership and activity of East Coast Alliance groups. Information is available on the Alliance’s Web site at www.amaalliance.org, or by contacting the national offi ce for more information.

November 15, 2007: Great American Smoke Out DayThis issue of Alliance Today features a simple way to get involved in the Screen Out! campaign in conjunction with the Great American Smoke Out on November 15. The insert (between pages 10 & 11) contains six postcards with postage included that can be torn out, signed and dropped in your mailbox to be sent to the six largest movie studios in the U.S. encouraging them on November 15 to support the Great American Smoke Out by getting smoke out of youth-rated fi lms. Join the campaign through this simple eff ort and drop these six postcards in the mail with your signature.

The Screen Out! campaign is supported through a grant from the American Legacy Foundation, the largest national independent public health foundation dedicated to keeping youth from smoking and helping smokers quit. Screen Out! actively utilizes AMA Alliance members, creating a parent-to-parent grassroots initiative to make future movies rated G, PG and PG-13 smoke-free. Screen Out! Project Coordinator, Melissa Walthers, works out of the national AMA Alliance offi ce to assist in the organization, coordination and dissemination of Screen Out! campaign activities and materials to all Alliance members in an eff ort to achieve the end goal of reducing youth exposure to tobacco imagery in fi lms.

This edition of Screen Out! News was written by Melissa Walthers.

Screen Out! News

Screen Out! News

Published letter by Julie Freeman, AMA Alliance member, in the August 1, 2007 edition ofMontgomery Advertiser Audience: 2,017

September/October 2007 AMA Alliance Today 9


Health Report

Study indicates statins may reduce risk of Alzheimer’s disease A recent study conducted at the University of Washington suggests that statin drugs may reduce the risk of Alzheimer’s disease. A new study published in the journal Neurology reports that people who take cholesterol-cutting statin drugs may be less likely to develop Alzheimer’s disease brain abnormalities. Researchers led by University of Washing-ton’s Gail Li, M.D., Ph.D., conducted brain autopsies on 110 people who died during a long-term study of brain health. The participants enrolled in the study when they were at least 65 years old (average age: 74). When they joined the study, they had healthy minds and this was monitored by mental skills tests conducted every other year for up to eight years. If they scored poorly on those tests, they were screened for dementia.

According to the researchers, “The brain autopsies showed that participants who had taken statins were 80 percent less likely to have brain changes typical of Alzheimer’s disease than those who hadn’t taken [the drugs].” This figure was adjusted for risk factors including age, gender and mental skills test scores when the study began. WebMD notes that the study doesn’t prove that statins prevent Alzheimer’s disease, and the researchers stress the need for additional studies to determine this.

Source: WebMD Medical News, August 27, 2007

Research suggests cranberry juice may aid ovarian cancer treatmentPatients diagnosed with ovarian cancer may want to consider stocking up on cranberry juice. According to a study present-ed at the national meeting of the American Chemical Society in Boston, a glass of cranberry juice every now and then may greatly boost an ovarian cancer patient’s sensitivity to chemotherapy. Chemotherapy treatment commonly centers on so-called “platinum drugs,” such as cisplatin and parapla-tin. In a comprehensive article in HealthDay it was reported that researchers collected ovarian cancer cells from patients experiencing platinum drug resistance and exposed some of the cells to a purified extract drawn from a store-bought cranberry drink that contained 27 percent pure juice. After researchers treated all the cells with paraplatin chemotherapy, they found that cells pre-treated with the juice extract were killed at a rate that was equal to six times that of cells unexposed to cranberry component and the juice appeared to slow both the growth and spread of some cancer cells.

Though it is not yet clear how cranberry juice might kill ovarian cancer cells, researchers note that the “A-type” proanthocyanidins protein, only found in cranberries, “appears to bind with—and block the activity of—tumor proteins found in ovarian cancer cells, increasing their sensitivity to chemo.”

Source: HealthDay, August 21, 2007


of flames traveling rapidly from the hem of my jacket toward my neckline, unimpeded, nay facilitated, by the quilted fabric.

Linda was still sputtering, “You’re lit up,” but now I knew what she was trying to tell me. For a moment—the briefest of pauses—I pondered the inadvisability of throwing the jacket onto the well-worn carpet and possibly sparking a big-ger blaze, but then self preservation kicked in and I divested myself of the offending jacket by flinging it away from me. Not to worry. Linda #2 knew just what to do. She threw herself into the breach, stomping on the disgraced piece of clothing with all the vigor of a Flamenco dancer and then when that didn’t do the trick, picking up the jacket by the unlit corner and beating it against the floor.

The rest of us at the table were also standing up by now, watching the scene in dismay. I noticed as an afterthought that the room had grown quiet and still. I learned later that my coworkers at the spaciously spaced other tables couldn’t see quite what was happening and surmised that my impend-ing departure had emboldened me to throw caution to the wind and say something so offensive that Elizabeth and Linda #1 didn’t even want to sit at the same table as I, and Linda #2 was taking revenge on my wardrobe. But Linda #2 had figured out just what to do and the only casualty of the day’s events was the red quilted jacket.

But I often think of that day when I’m pondering the nature of communication and trying to determine how to get an important point across. What I learned from the experience is that whether you’re trying to save a recalcitrant co-worker from going up in flames or attempting to let a legislator know how important it is to your community to protect the State Children’s Health Insurance Program, fix the Medicare physician cuts once or for all, or to do something about all the smoking images in movies, success depends on commu-nicating in context (taking into account your audience’s frame of reference), paying attention to the nonverbal cues, and planning how to follow your message with action if it doesn’t garner the result you intend.

Knowing how to communicate your message effectively and how to bolster your words with action is essential because sometimes “you’re lit up” means “you’re drunk.” Other times, it means “you seem to be in an especially good mood today,” but occasionally it means: “You’re on fire! Do some-thing!” And knowing both which context is relevant to the situation, and what to do if your audience doesn’t understand you, can mean the difference between a moderately singed jacket and a truly unplanned farewell.

You’re All Lit Up—Do Something! continued from page 5


Maybeyoushouldskipdessertthistime.Haveyoulostweightbecauseyoulookgreat?IfonlyIwereasizefourinsteadofasizesix.Thosepantsmayfitabitbetterhadyounoteatenthatextrabowloficecream.IwishIwerejustfivepoundslighter. Alloftheseareexamplesofthetypesofstatementsthatmostpeoplehavethoughtorsaidtothemselvesorothersatsometimeoranother.Whiletheyexpresswhatpeoplefeelandmaysoundharmless,asimpleturnofphrasecanspeakvolumestoanimpressionablechild. Forparentswiththebestofintentions,speakingthoughtful,encouragingwordsmaymakeaworldofdifferencefortheirchildren.Aschildrengrowandstarttodevelopanimageofthemselves,thecommentstheyhearandwhattheyaretoldmay

provetobethedifferencebetweenanegativeandpositiveselfimage. RebeccaPuhl,Ph.D.,ofYaleUniversitysurveyedmorethan2,400overweightandobeseadultwomenwhofeltstigmatizedduetotheirweight.Thestudyfoundthatbeingthetargetofstereotypes,meanjokesornegativestigmatizationfromfamilymembersduringchildhoodwasverycommon., “Overweightandobesechildrenare

vulnerabletoarangeofnegativeconsequencesthatincludelowerself-esteem,depression,poorbodyimageandsuicidalbehaviorasaresultofbeingostracizedinchildhood,”saidPuhl,aclinicalpsychol-ogistwhoworksattheRuddCenterforFoodPolicyandObesity. Althoughit’sobviousthathurtfulwordscanscaremotionally,moreoftenthannotit’sthethingsthatparentsarenotawareofthatcanresonatethemost,saidPuhl.Attitudesandbehaviorscanbejustasdamningasspokenword.Shecitedtheimportance

ofbeingintouchwiththepersonalassumptionsaboutweightthatmostpeoplefoster.Shesuggestsparentstakeastepbackandevaluatetheiringrainedpointofviewsthatcouldbepotentiallyharmful. “Asaparentit’simportanttobeintouchwithweight-basedassumptions,”shesaid.“It’simportanttointrinsicallyevaluateourperceptionsandopinions.Manynegativeattitudesaresoingrainedinoursocietythatwedon’trecognizethem.” AccordingtoJoanChrisler,Ph.D.,aprofessorofpsychologyatConnecticutCollege,parentsareveryimportantrolemodelsfortheirchildren,especiallyparentsofthesamegendertotheirchildren.Daughterspayattentiontowhatmotherssayanddo.“Iwouldencourageparentstofocusonotherthingsbesidesappearance,liketheirchild’sgrace,strength,athleticabilityandtalents,”saidChrisler.“Talkingmorebroadlyandfocusingonthepositivehelpschildrentoaccentuatetalentsandability.” Eventhoughparentscaninevitablysetthefoundationforahealthyandstableself-image,itisoftenoutsidesourcesthathaveanimpactonachild’sperception.ThisiswhybothPuhlandChrislerencourageparentstoteachtheirchildrentobecriticalthinkerswhenitcomestothemedia.“Themediaisfullofcontradictionsandstandards.Therearesomanymixedmessagesandidealsthatareverystrictandunrealistic,”saidPuhl.“It’suptoparentstohelptheirchildrenchal-lengethesemediaimagesandasktheimportantquestions.” Chrislerconcurred,notingthatthiscanbestbedonebymodelingcriticalthinkingwhenviewingthemedia.Ifaparentseesmodelsthatarestickthin,it’simportanttopointouthowun-healthyitcanbewhensothin.Theywillfollowyourlead.

By: Jennifer WestWatch What You Say!

RebeccaPuhl,Ph.D.,fromtheRuddCenterforFoodPolicyatYaleUniversity,andJoanChrisler,Ph.D.,ProfessorofPsychologyatConnecticutCollege,offerthefollowinghelpfulhintstopromotepositiveself-imageinchildren:

• Don’t talk negatively about your weight. Asking“doyoulikethecolorofthisdress”insteadof“doesthisdressmakemelookfat”tellschildrenthatclothingcanbefunandfunc-tionalandnotjustameanstodisplayphysicalattractiveness.

• Don’t compare yourself with other people in a negative way. Whilethisisanaturalhumantendency,trynottosayitoutloud.Thisshowsthatyouarenotsatisfiedwiththewayyoulookandthereforesendsthemessagethattheyshouldtrytochangealso.

• Try to instill a sense of uniqueness and inner beauty.Parentsshouldemphasizeotherqualitiesbesidesappearance,

suchastheirchild’sgreatsenseofhumor,pianotalents,sportsskills,goodgrades,etc.Thissendsthemessagethattheyaremorethancuteandpretty,butmoreimportantlytheyaresmartandtalented.

• Don’t brush off compliments. Thisisakindofself-depreciationthatsaysthatyouareunworthyofbeingcompli-mented.Thistranslatestoanegativeself-imageandsetsabadexample.

• Don’t describe foods as good or bad or exercise as a chore. Insteadencouragemoderationandvarietyineatingallkindsoffoodsandexercisingasfunandhealthyforthebody.

• Set standards of acceptable behaviors and outlooks.Childrenaresurroundedwithalotofnegativeinfluencessoit’simportanttodoyourpart.Findwaystocommunicatethatyourfamilyhascertainstandardsandencouragecriticalthinkingwhenviewingthemedia.

Rebecca Puhl, Ph.D.

Joan Chrisler, Ph.D.

September/October 2007 AMAAllianceToday11


12AMAAllianceTodaySeptember/October 2007

Issues Watch

LegislationwasintroducedintheU.S.HouseofRepresentativesthatwouldinitiallylimitthemandatoryuseoftamper-resistantprescriptionpadsfornon-electronicwrittenprescriptionsunderMedicaidtoScheduleIInarcoticdrugs.ThiswillotherwisedelaytheapplicationoftherequirementtootherprescriptionsdrugsuntilApril1,2009.TitleVIIofthe2007supplementalappropriationsbillincludedamemorandumonaMedicaid-proposedruleissuedinJanuary2007 that would have placed new restrictions on the methods states use to finance their share of Medicaid costs. To offset the cost of this moratorium, the law requires the use of tamper-resistantprescriptionpadsforallhandwrittenMedicaidprescriptionsasofOctober1,2007.TheCentersforMedicareandMedicaidServices(CMS)isscheduledtopublishaguidancememofor state Medicaid directors this month with specific details regarding the law’s requirements. BoththeAMAandtheAlliancearemonitoringthisissueandhavesentbackgroundinforma-tiontomembers.TheAllianceissuedanalerttomembersonJuly25askingthemtoevaluatehow this legislation might effect medical practices, and requested feedback to help the Alliance workwiththeAMAtobuildmomentumonthisissue.TheAMAandmanyotherstakeholderspursued this issue on behalf of physicians and pharmacists during Congress’ summer recess. TheAMAhasalreadycommunicatedseriousconcernstotheCMSthatthisextremelyshortimplementation timetable could lead to significant prescription drug access problems for Medicaid patients. It advised the agency that the new federal requirements could conflict with state requirements and impose significant new costs on medical practices. The AMA strongly urgesatransitionperiodof6-12monthsforstates,physiciansandprovisionforemergencydispensingwhenprescriptionsarenotwrittenontamper-proofpads.

CMS officials have indicated that current state requirements would likely be grandfathered so that the federal standards would not conflict with them on issues such as the particular types of pads that would be acceptable. CMS also indicated that it is making a major effort to provide foremergencydispensing.TheagencyiscurrentlytryingtodevelopguidanceforallstateMedicaiddirectors.

OnJuly19,Reps.CharlesWilson,D-Ohio,MarionBerry,D-Ark.,andMikeRoss,D-Ark.,introducedH.R.3090,the“PatientandPharmacyProtectionActof2007,”thatwouldlimitthetamper-proofprescribingpadrequirementtoScheduleIIcontrolledsubstancesinsteadofhavingitapplytoallprescriptions.Thislegislationwouldlimitbutnotdelaytherequirementeffective October 1, 2007.

Inthemeantime,inTexas,thanksinparttotheTexasMedicalAssociation,HealthandHuman Services Commissioner Albert Hawkins has decided the state’s physicians don’t have to makeanychangesinprescriptionpadsusedforMedicaidpatientsonOctober.1.HawkinssaidthestateisworkingwithCMStodeterminewhenandhowtoimplementthenewrequirement.

Source: American Medical Association, September 3, 2007, and other sources

Americans Without Health Benefits Tops 47 Million AccordingtotheBloombergnewsorganization,thenumberofpeopleintheU.S.withoutmedical insurance rose five percent to a record 47 million in 2006, adding to the national debate overhowtoprovidehealthcoverageforeveryone. Duringthesametimeperiod,thenumberofuninsuredchildrenincreasedto8.7million,or11.7percentofallkids,from8million,or10.9percent,in2005,accordingtothenewsagency.It also reported census bureau figures in August 2007 that showed that the share of U.S. residents inpovertyfell0.3percentagepointsto12.3percentofthepopulation. Thenumberofpeoplelackinghealthinsuranceincreasedevenasthemedianhouseholdincome adjustment for inflation rose less than 1 percent to $48,200 last year, the Census Bureau said. Median household income remained less than in 2000, considering inflation.

Source: Bloomberg News, August 28, 2007

This edition of Issues Watch written by Jennifer West.

Update on Medicaid Tamper–Resistant Prescription Pad Requirement

Do you have an axe to grind? MaybeyouhaveanopiniontoshareaboutsomethingyousawinAMA Alliance Today?Orjustafewchosenwordsabouttheissuesfacingyourcommu-nityortheworldingeneral?We’lllisten.Putdownyourthoughtsandsendaletterto:

EditorAMA Alliance Today515N.StateStreet,9thFloorChicago,IL60610

Afewparagraphsinaletternotenough?Sendusaguestcommentary.Pleasekeepyourcommentsdownto500wordstogiveeveryoneachancetobeheard.

Andwhilewe’llbehappytowithholdyournameuponrequest,wecan’tconsiderunsignedlettersorcommentarythatdon’tlistthecityandstatewhereyoulive.



TheAMAAlliancecontinuestoexpanditscommitmenttoeducatingchildrenonhealthawarenessandresponsiblebehaviorwiththereleaseofarevisedversionoftwoofitsactivitybooks:Hands are Not For HittingandYou Don’t Have to Be Bullied.

TheHealthPromotionsCommitteehasworkeddiligentlyoverthepastyeartoupdatetheartworkandwordingforthesetwopublications.Hands Are Not For Hittingreinforcesnon-violentconductandteacheschildrenpositivebehavior,identifyinggoodandbadwaystousetheirhands.You Don’t Have to Be Bulliedfeaturessimilarthemes,providingdialogueontheeffectsofbullyingonchildrenandofferingstrategiestopreventit.Throughmazes,picturefindsandothercoloringactivities,childrenlearnhowtodealwithbullying.Withthemoveawayfrompeermediation,theHealthPromotionsCommitteefeltitwastimelytorevisethebookletsusingcurrentbestpracticeguidelines.

OntheagendathisyearforrevisionisthebookI Can Be Safe, whichteacheschildrentheimportanceofsafetywhileathomeandatplay.Oneofthefirstbooksintheseries,thisbookwillbeupdatedtoincludeInternetsafetyappropriateforyoungerchildren.ThecommitteewillalsomakechangesintheactivitybookI Can Be Healthy,

whichfocusesonhealthyeatingandexercise.

OtheravailablebooksincludeI Can BeandI Can Choosethatteachchildrenaboutbeingkind,honestandconsiderateofotherswhomaybedifferentthantheyare.Thebooksenforcevaluesofself-esteemandconflictresolution.

The AMA Alliance activity book series is useful and affordable. It costs

members only $15 for a pack of 25 books! Order your set of activity

books on the next page and watch the children in your local schools,

churches and community respond to these positive messages, which

are building blocks for healthy living.

Growing with Our Children

Health Promotions Committee Updates Activity Books

By Jennifer West

Ontheagendathisyearforrevisionisthebooktheimportanceofsafetywhileathomeandatplay.Oneofthefirstbooksintheseries,thisbookwillbeupdatedtoincludeInternetsafetyappropriateforyoungerchildren.Thecommitteewillalsomakechangesintheactivitybook

Otheravailablebooksincludeteachchildrenaboutbeingkind,honestandconsiderateofotherswhomaybedifferentthantheyare.Thebooksenforcevaluesofself-esteemandconflictresolution.


You Don’t Have ToBe BulliedGenerates a dialogueabout bullying, itseffects on children andstrategies to prevent it.Through mazes, picturefinds and other coloringactivities, children learnhow to resolve a conflict.

Appropriate through 5th grade. Package of 25.

$15.00 (member) $25.00 (nonmember)

Hands Are NOT for HittingReinforces non-violent behaviors.Children learn positive behavior andidentify what theirhands should andshouldn’t do. Packageof 25.


I Can Be HealthyAddresses the issues ofobesity amongst youngpeople and promoteshealthy habits—fromthe foods they eat to regular physical activity. Appropriatethrough 5th grade.Package of 25.


I Can Be SafeUsing picture finds,connect-the-dots andmazes, children learnsafety at home and at play. Package of 25.


I Can Be...Through mazes, connect-the-dots and other coloringactivities, childrenlearn to be kind, honest, healthy andmore. Package of 25.


I Can ChooseChildren learn self-esteem and conflictresolution skills whilecompleting word finds,mazes and drawings.Package of 25.


1 set of 6 books (1 of each)$4.00 (member) $6.00 (nonmember)

Healthy LifestylesCD-ROMPrintable games forchildren, posters andmuch more. Use thenutrition and fitnessfacts and tips toaccompany the “I Can

Be Healthy” activity book and to reinforcethe importance of making healthy lifestylechoices.


Products and PublicationsChildren’s Activity Book seriesSix activity books for children in kindergarten through third grade offer creative exercises that teach young readers about nutrition,safety, self-esteem and conflict resolution. The books help kids to focus on making healthy, positive choices. The series includes:

5 sets of 6 books (30 total)$20.00 (member) $24.00 (nonmember)

10 full sets (all 6 books, 60 total)$30.00 (member) $50.00 (nonmember)

To learn more, visit www.amaalliance.org.

Please print or attach business card (no P.O. Boxes please)

Name __________________________________________________________________________________________

Mailing address__________________________________________________________________________________

City/state/ZIP ____________________________________________________________________________________

Telephone____________________________________ E-mail__________________________________________

Payment information

� Cash � Check number ______________________________________________________________________

� VISA � MasterCard Card number____________________________________ Exp. date ____________

CID number (three-digit code in the signature panel of your credit card) ________________________________

Please allow 3-4 weeks for delivery. If faxing, fax to (312) 464-5020.

Member price Nonmember price Quantity Total Shipped Yes/NoChildren’s Activity Book seriesI Can Handle Bullies $15 / 25 $25 / 25Hands Are NOT for Hitting $15 / 25 $25 / 25I Can Be Healthy $15 / 25 $25 / 25I Can Be Safe $15 / 25 $25 / 25I Can Be $15 / 25 $25 / 25I Can Choose $15 / 25 $25 / 25

Set of 6 books (1 of each) $4.00 $6.005 sets of 6 books (30 total) $20.00 $24.0010 sets of 6 books (60 total) $30.00 $50.00

Additional products for a healthy lifestyleHealthy Lifestyles CD-ROM $9.00 $14.00Talk to Your Kids About Bullying bookmark $5.00 / 50 $6.00 / 50Hands Are NOT for Hitting placemat $18.00 / 100 $22.00 / 100

Physician Spouse seriesThe Medical Marriage $25.00 $30.00The Handbook of Physician Health $40.00 $45.0012 Steps to a Carefree Retirement $35.00 $45.00

AMA books seriesDiabetes Cookbook $14.00Type 2 Diabetes Cookbook $14.00Healthy Heart Cookbook $14.00Hypertension Cookbook $14.00AMA Family Medical Guide $27.00A Piece of My Mind $12.00The Art of JAMA I $29.66The Art of JAMA II $29.66The Art of JAMA I and II set $50.00The Soul of the Physician $27.00

AMA Alliance logowear Price Size/color (if applicable) Quantity Total Shipped Yes/NoWhite adult t-shirts (S, M, L, XL) $10.00 Hooded grey sweatshirts (S, M, L , XL) $25.00 Women’s u-neck white shirts (S, M, L, XL), $25.00Black duffel bags $20.00 Baseball caps (stone, green, dandelion, black) $10.00

AMA Alliance Products and Publications order formAAA:07:06

02:500

:6/07

Talk to Your Kids aboutBullying bookmarkThis bookmark offers parentsand teachers simple tips onhow to talk to children aboutbullying. As a companionpiece to the popular “I CanHandle Bullies” activitybook, the bookmark rein-

forces the message that bullying is notacceptable. By talking with children aboutbullying, parents can offer guidance, support and assistance. Package of 50.


Hands Are NOT forHitting placematThis paper placematteaches preschoolthrough third grade

children positive, nonviolent activities andacceptable ways to treat others. “Hands” is a simple hand-tracing exercise with a funactivity on the back for parents or teachers to work through with children. It provides athought-provoking, creative look at nonvio-lent ways of communicating. Package of 100.

Reduced price while supplies last!$18.00 (member) $22.00 (nonmember)

SubtotalDiscount amount

9% sales tax per State of Illinois Shipping and handling

TOTAL DUE

Discount code:

Additional products for a healthy lifestyle


Ifyouhavebeentoagrocerystoreinthelastmonthorso,youhavenoticedthatthemajorityofproductsontheshelveshave

startedannouncingthattheycontain“0gramsTransFat.”Mostconsumerscandeducelogicallythatthisisagoodthingwithoutreallyknowingwhatitmeansorwhattransfatreallyis.Transfatisacommonnameforatypeoffatthat,unlikeotherdietaryfats,isneitherrequirednorbeneficialforhealth,increasingtheriskofcoronaryheartdisease.Butwhy,allofasuddenthisyear,arefoodcompaniesstartingtoadvertisetheirlackoftransfat?Itmakesonewonderastotheleveloftransfatconsumeduptothispointandwhatelsemightbeinfoodsofwhichweareunaware. Asconsumers,onewayofbeingawareofwhatweeatisbycheckingoutthenutritionlabelsonourfavoritefoods.Butoneshouldbeawareofsuchinformationandunderstandwhatitmeans.StephenHavas,M.D.,M.P.H.,M.S.,VicePresidentofScience,QualityandPublicHealthfortheAMA,explains,“Peopledon’tknowhowtointerpretthenumbersonthelabels.Theydon’tknowwhatishigh,lowormedium,andthisinformationshouldbeprovidedforbetterunderstanding.” HavasexplainsthattheAMAhasbeenpushingforahigh/low/mediumsystem,similartoastoplight,thatconsumerscanunderstandintuitively.Forexample,medium(yellow)sodiumisnotgood,andalotmorethanthat(red)isreallybad.“Unlessyoucompareacrossmanydifferentbrands,youwon’tknowwhatishighandwhatislow,”explainedHavas.“Consumersshouldn’thavetosearcharoundforthesedetails.Itshouldbemadeeasierandabletobeunderstoodwithoutin-depthexplanations.” “Themostcommonmisunder-standinginrelationtofoodpackagingisservingsize,”addsDonaldHensrud,M.D.,M.P.H.,aPhysicianNutritionSpecialistattheMayoClinic.“Theamountpeopleeatisn’tusuallyaserving,andconsumersneedtomakethatdifferentiationbetweenportionandservingsizes.”Heexplainsthatcerealsareagoodexampleofportionandservingsizesbeingblurredtogether.

Inallactuality,anormalsizebowlcanholdtwotothreeservingsofcereal,makingthecaloriesconsumeddoubleortripletherecommendedamount.“Onthefrontofapackage,inbigboldprint,shouldbethenumberofservings,”saidDr.Havas.“Amuffin,forexample,shouldread‘Contains3Servings’toavoidanyconfusion.” AccordingtoHensrud,anothercommonmistakeiscompar-ingvolumeoffoodonaplate.“Volumeoffooddoesnotcorrelatewithnumberofcalories,”heexplains.“Sometimespeopleseevolumeandthinkthatgreatervolumeequalsmorecalories,buttherearethesamenumberofcaloriesinoneandone-thirdsticksofbutterastherearein35cupsofgreenbeansor10-11headsoflettuce.”Thisiswhatphysiciansanddieticiansmeanwhentheytalkaboutportioncontrolinhealthydieting.Butservingsizeisnottheonlypartofthelabelthatshouldbeconsidered.Bothphysiciansagreethatlevelsofsaturatedfat,sodiumandtransfatshouldbekepttoaminimum,ashighlevelsonaregularbasiscanleadtochronichealthproblems—heartdisease,cancer,stroke,diabetes,highbloodpressureandhighcholesterol—allofwhicharepreventable. Hensrudsaysthatnutrientstolookforonafoodlabelthatsomepeopledon’tgetenoughofarepotassium,fiberandcalcium.“Butthefoodsthatarereallygoodforyoudon’ttypicallyhavelabels,likefruitsandvegetables,”addsHavas.“Theyarenaturalproductsandinherentlyhealthy.”Hensrudagreesthatwhileunderstandingnutritionlabelsisimportant,takingastepbackandunderstandingthebasicfoodguidelines,likethefoodpyramidmanylearninelementaryschoolhealthclass,isthefirststepinlivingahealthylifestyle.“Foodlabelsarepotentiallyveryimportanttoprovideinformationtohelpmakedietarychoices,butconsumersneedtounderstandclearlywhatthelabelsmeanwhiledoingabetterjobofputtinganoverallhealthydietpatternintoperspective,”saidHensrud. “VeryfewpeopleintheU.S.arevitamindeficient,”notesHavas.“Halfthepopulationistakingvitaminsupplementsandtheydon’tneedthem.Ifyouhaveabalanceddiet,yougetallthenutrientsyouneed,andanyexcessvitaminsarethenurinatedoutofyourbody.”Unlessfederalregulationforcesfoodcompa-niestostartexplainingtheircontentsbetter,itistheconsumer’sresponsibilitytotaketheirownhealth,andthehealthoftheirfamily,intotheirownhands. “Nutritionisoneoftheprincipaldeterminatesofhowhealthysomeonewillbeintheirwholelife,andapersoncantakecontrolovertheirdietpatternatanyage,”addsHavas.“Thesooneryoustart,thebetter.”

By: Leia Vincent

For information about how to read the nutrition labels on your favorite foods, visit the AMA Alliance Web site at www.amaalliance.org.


Nutrition LabelsUnderstanding

DonaldHensrud,M.D.,M.P.H.


“MiddleAmericavolunteersmost,surveyfinds,”wasthetitleofaUSA TodayarticlepublishedJuly9,2007.ThearticlereportedthatpeopleincitieslikeMinneapolis,SaltLakeCityorAustinweremorelikelytovolunteerthaninotherurbanareas.Thearticlechalksituptoabasicconnectionbetweenvolunteersandtheircommunities,stating“residentsofcitieswherepeoplespendalotoftimecommutingorliveinapartments[likeNewYorkandMiamiwhichrankedlowest]tendtofeellessconnectedtotheircommunities,sotheydon’tvolunteerasmuch.”Butthedatainreportssuchasthisonedoneusingphoneandin-personinter-

viewscanbeskewed.Itreallydependsonthewordingofthequestionsbecausethedefinitionoftheword“volunteer”canbemisleading. SusanJ.Ellis,presidentofEnergize,Inc.,aconsulting,trainingandpublishingfirmspecializinginvolunteerismformorethan30years,explainsthatitisveryimportanttorealizewhatistypicallyconsideredvolunteerworkisonlypartofthepicture--muchofitgetsleftout.“Dataisnotnecessarilycollectedfortaskscalledsomethingelse,suchasdoctorsandlawyerswhoworkonacharitycaseandsimplycallit‘probono’work.Thatisacaseofvolunteerismthatshouldbeacknowledgedbutiseasilyover-looked,”saidEllis. AnotherverypublicexampleEllisspokeofwasthepublicserviceprovidedbypublicfigures,likeCaliforniaGovernorArnoldSchwarzenegger,NewYorkCityMayorMichaelBloom-bergandformerPresidentJohnF.Kennedy,allofwhomdidnotaccepttheirsalarywhileinoffice,effectivelymakingtheirjobtitle“publicvolunteer.” Alotoftimeisspentasavolunteerthatapersonmightsimplyconsider“work.”Thatiswhyweoftenhearasocialservicesorganizationorpoliticianfreshlyelectedsaying,“Iwouldn’tbeheretodayifnotforallthevolunteers.”Volunteersareeverywhere,andalmosteveryonevolunteersinsomeway,whethertheyknowitornot. Ellis’sfavoritephraseis“volunteeringissopervasive,it’s

invisible,”whichiswhyshecameupwithaMapoftheVolunteerWorldthatcanbefoundonherWebsiteatwww.energizeinc.com.Itshowsthemanydifferentformsofvolunteerism,helpingtoeducateaboutthetypesofvolunteeringthatoftengounrecog-nizedbecausetheyarelabeledwithdifferentnames:service-learning,layministryoractivismasthreeexamples. Ontheotherhand,everyoneknowsthatvolunteeringincludesmoreobviousactslikehelpingoutHabitatforHumanityortheAmericanRedCrossincrisissituations.SincetheAMAAllianceisamembershiporganization,allmembers,officers,

committeemembersandboardmembersarevolunteers.Whichbegsthequestion,wouldamemberconsidertimespentatalocalAMAAlliancemeetingastimevolunteering?Theyshould! “Peoplearedrawntodifferentthingsatdifferentpointsintheirlives,”saidEllis,commentingonthemanyreasonsforvolunteeringpeoplehavesharedwithheroverhermanyyearsinthefield.Somepeoplevolunteerforacausethatwillteachthemsomething.Somevolunteertoimprovetheirresume.Stillothersarehelpingoutwhileexploringanewcareer,somethingthatusedtobedoneprimarilybyyoungpeople,butmoreandmoreolderpeoplearevolunteeringinthehopesofestablishingamajorcareerchange.Othersneedasocialoutlet,wanttobeoutdoorsorhaveadeepconnectiontothecause,likeadiseaseorpersonalmilestoneovercome. “Thereareliterallyahundredreasonswhypeoplestartvolunteering,butwhat’smoreimportantiswhytheystay,”explainedEllis.“Theyseethatwhattheyaredoingmatters,theyarelearningandgrowing,theylikethepeopletheyareworkingwithandfeelappreciatedfortheworktheydo.” AnotherformofvolunteerismthatAMAAlliancememberswillrelatecloselytoisworkthatisadirectextensionofparenthood,suchasbeingapartofthePTA/PTO,coachingLittleLeagueorbeingaBoy/GirlScoutsleader.Eventhoughyourchildbenefitsfromyourinvolvementintheseactivities,thelivesofsomany

ChangingBy Leia Vincent photos courtesy of VoLunteermatch.org



otherpeople’schildrenaretouchedbyyouractoftimegenerosity,timebeinganon-renewableresourceinforever-busylives. “Onebadrepaboutvolunteerworkthatmakespotentialparticipantsshyawayistheassumptionthatitwillbeanendlesscommitment.Awardsaregiventopeoplefor‘25YearsofService’andothersthink‘ohmyword,Idon’thavethatkindoftime,’butthereisalwayssomethingthatcanbedonetofitanytimerestraintaprospectivevolunteermighthave,”saidEllis.ShementionsorganizationssuchasHandsOnNetwork(www.handsonnetwork.org)whichallowpeopletoregisterlocallyand

receiveamonthlycalendaroflocalvolunteeractivitiesthatcanbeworkedinthree-hourintervals.“Thismakesforaveryorganizedwayofvolunteeringinshortbursts,”saidEllis. Intheelectronicagethatwelivein,thereisalsoaneveneasierwayofvolunteeringtimeandskillswithoutevenleavingthecomfortofhome.It’scalled“virtualvolunteering”wherevolunteeringcanliterallybedonewhilesittingathomeinpajamas.Forexample,theU.N.OnlineVolunteeringProjectpartnersvolunteersinthedevelopedworldtothoseneedingtechnicalsupportinthedevelop-ingworld,sharingadviceandexpertisefromonecountrytoanotherwithouteverhavingtoleavethecouch. Another“time-restriction”reasonfornotvolunteeringisthattimewithchildrenandfamilyisalreadylimited.“Onethingwetrytoemphasizeismakingtimetovolunteerwiththefamilyandchildren.Therearemanyactivitiesappropriateforchildren,likevisitingaseniorcenter,workinginananimalshelter,ordeliveringbasketsofsuppliesfromthelocalfoodpantry,”saidEllis. OneofthepopularandmostextensivelistingsofvolunteeractivitiesacrossthecountryisVolunteerMatch.orgwithmorethan100,000visitorsaweek.ItisanonprofitInternetservicelaunchedin1998thatmakesiteasytosearchforvolunteeropportunitiespostedbylocalorganizationsbyZIPcode,key-wordsorotherspecifiedparameters.“VolunteerMatchisreallytheplacetogotofindvolunteeractivitiesyoucandoinyour

ownbackyard,anditmakesgettinginvolvedaseasyasusingasearchengine,”saidVolunteerMatch.orgspokespersonRobertRosenthal.“It’samorestrategicwayforAMAAlliancememberstofindopportunitiestoworkforacausethatintereststhem-andperhapseventuallyencouragetheirspousestogetinvolvedonaprobonobasis,too.” Animportantthingtorememberisthatmostvolunteerorganizationsarerunbyvolunteers,forvolunteers.“Therearemany,manyestablishedorganizationslookingforvolunteers,andtheyarebecominghouseholdnamesandthuseasiertofind,”

saidEllis.“Somehavebeenaroundfordecades,andbecauseoftheInternet,eventhemoreobscureorganizationsaregettingthewordoutandbecomingeasiertofind,makingtheperfectvolunteeropportunityavailabletomatcheachperson’sinterest.” Differentpartsofthecountryandworldhavedifferentvolunteerneedstobemet.“Forexample,NewYorkmayhavemoreofaneedforyouth-drugpreventionprogramsthanNorthDakota,butafatherinNorthDakotatakingaBoyScouttroophikinginthewoodsisdoingnothinglessthanthoseNewYorkvolunteersbyaddressingandfulfillinganeed,”saidEllis. So,canonepersonreallymakeadifference?Therearemanyexamplesthatprovethistheorycorrect.“Everythingbeginswithonepersonwillingtotakeonestep,”saidEllis.“Givingmoneydoesn’thaverisk.Whenapersonputstheirbodywheretheirbeliefsare,theyaretakingarisk.Toseeanddealwithrealissuesyoucareabout,addingenergytoeffort,thereisnoquestionastohowonepersoncanmakeadifference.” Ellis’sfavoriteexampleofonepersonstartingamovementisCindyLightner,creatorofMothersAgainstDrunkDriving(MADD).“Itallstartedwithonemother’spain,”saidEllis.“Shehittherightnoteattherighttimeandtheworldchanged.Allittakesisalittleheartandalotofeffort.” Forlinkstovolunteerresources,visittheAMAAllianceWebsiteatwww.amaalliance.org.

One VolunteerataTimeChanging The World




County News

West Virginia County Alliance Recounts Productive Year TheCabellCountyMedicalSocietyAlliance(CCMSA)hadaverysuccessfuland rewarding year, and hopes to top last year’s achievements in the 2007-08 Allianceseason.

InNovember,theorganizationhosteditsannualHolidayBazaar,abigfundraiserfor the CCMSA. Members accumulated more than 25 raffle prizes, including a $500 itemfromalocaljewelerwhoalwaysdonatessomethingbeautifultoauction.About90 people attended the glamorous event and more than $4,000 was raised for charities.

InDecember,CCMSAhelditsAMAsharingcardprojectandraisedmorethan$3,000, while in March the organization held the second big fundraiser called Bonnet Buffet. The event featured a mother-and-child fashion show and raffle for a number of items, including a beautiful ring. The group raised $2,000 for local charities.

Overall,theorganizationraisedabouttenthousanddollarsandthemoneywenttotheScottishRiteChildhoodspeech-and-languageprogramatMarshallUniversity,Cabell-HuntingtonCoalitionfortheHomeless,HospiceofHuntington,RenaissancePlace, Contact 24-hour crisis center and Ebenezer Medical Outreach.

WhileitisaverybusyAlliance,membersmakesuretohavefunaswell.“Wehavea craft group, book club, ‘Movies and Margaritas’ group, a bowling team and a tennis clinic,”saidPamAkers.“Thisisagreatgroupofwomen!”

Formoreinformation,[email protected].

Texas County Alliance Receives State Award for Fundraising Efforts TheMedicalAllianceofBellCounty(MABC)wontheTexasMedicalAssociationAlliance(TMAA)awardfor“DedicationtotheMission”foritsCaringBallFundraiser,which raised $137,000 to benefit the Temple Community Free Clinic.

MABChasbeencloselyalignedwiththefreeclinicsinceitsinceptiononOctober22,1992.Initialfundingfortheclinicwasstrictlyfromcommunitydonations;however,afterjustafewmonths,itbecameapparentthatmoreresourceswereneeded to finance the clinic. The executive director of the clinic approached MABC andaskedthattheorganizationputtogetheraone-timefundraisertogiveacashboosttotheclinic.LikeMABC,thelocalAltrusachapterhadbeeninvolvedwiththeclinicfromtheonset.Thetwogroupsmetandmanyideaswereconsideredbeforethevenueofaformalballwaschosen.Manyyearslater,the“CaringBall”traditionwasborn. This “one-time” fundraising event has become a community-wide affair that involvesyear-roundplanning.

Morethan120volunteersfrombothorganizationsandthemedicalsocietyhelpedinsomewaythisyear.Morethan90ofthoseweremembersofMABC.Fromco-chairingthe Caring Ball itself to gluing decorations during a workday or stuffing nearly a thou-sandinvitationsintoenvelopes–morethantwo-thirdsofMABCmembershipwasactiveinsomewayonthisimportantcommunityserviceproject.

Thisyearthethemewas:“PuttingontheGlitz!NewYorkStyle.”TheCaringBallisconsideredacommunityevent,withmanylocalbusinessesprovidingfreeorreduced-cost products and services, and a myriad of citizens purchasing raffle tickets in hopes of winning the $7,000 donated diamond ring or the trip to New York City provided with the assistanceofthetravelagencyassociatedwithalocalhospital.

After raising an impressive $31,000 the first year, the Caring Ball has increased the amount of money raised each year, and reached a new record of more than $137,000 in2007.Thissinglefundraisingeventhelpsinstillcommunityprideaswellasprovideanimportantcommunityservicesothatallofitslocalcitizenshaveequalaccesstohealthcare.

Formoreinformation,[email protected].

This edition of State and County News was written by Leia Vincent and Jennifer West.



WhenAMAAlliancemembersdecidedtovolunteerattheIowaStateFair in August, they didn’t expect they wouldcomefacetofacewithsomanypeoplewhoarelivingonadailybasisascasualtiesofthepublichealthcrisisofbeingunderinsuredoruninsured. In conjunction with the AMA’s “VoicefortheUninsured”campaign,AlliancemembersKathyLariviere,BarbHanas,BarbSavageandMaryShuman,workedsidebysidewithmembersofthestatemedicalsocietyandAMAmemberstodistributeinformationabouttheinitiativelaunchedbytheAMAlastmonth.TheprogramaimstoprovideallAmericanswiththemeanstopurchasehealthcarecoverage,giveindividualschoicestoselecttheappro-priatecoverageforthemandtheirfamiliesandpromotemarketreformsthatenablethisnewapproach. InatypicalexampleofthestoriestheAlliancemembersheard:ShumanspentsometimetalkingtoDon,a26-year-oldbluecollarworker,marriedtohishighschoolsweetheartandworkingtoprovideforhisfamily.Althoughadequatehealthinsurancewasprovidedbyhispreviousemployer,heneededabiggerpaycheck,sohechangedjobsandconsequentlyendedupwithadifferentinsuranceprovider.WhenhiswifeSuebecamepregnant,theinsurancecompanyrefusedtopayanyofthecostsassoci-atedwiththepregnancycallingita“pre-existingcondition.” Theirsonwasbornandshortlyafterwasdiagnosedwithwhoopingcough.AccordingtoDon,“Theinsurancecompanykeptourmoneyandwewerestuckwiththebill.”Thefamilynowowes more than $12,000 in medical bills and still pays $6,500 a year for health insurance.Donisforcedtoworktwopart-timejobsinadditiontohisfull-timejob in order to recover financially. Thisisoneofmanystoriesthatstruckachordwiththevolunteersatthefair.“Iwasamazedathowsinceresomeofthepeoplewereastheysharedtheir stories about how difficult it is for themtoacquirehealthcarecoverage,”saidLariviere.Shumanaddedthatshe

foundmanypeoplewereworriedwhenthey read about conditions that aren’t coveredbyinsurance,suchasdialysisoroncologytreatments. “Therewasarealsensethatifpushcametoshove,youcoulddosomethingfortheuninsuredbuttheunderinsuredfelttheyweresittingducks,”shesaid.“Itwasakindofhelplessnessforthosewhomaycomeinjustunderthewireandessentiallyfallthroughthecracks.” Thevolunteersalsogatheredsignaturesforanon-governmentalpetitionthatAMAwilluseasevidenceinpresentingtheircasetopromoteoffering more options for the unin-suredandunderinsured. “Ourmaingoalwastoincreaseawarenessoftheissueoftheunderin-suredanduninsured,”saidSavage.“Wewantedfair-goerstosignthepetitionsoAMAcouldgobackwithconcreteevidencethatmanypeopleareinfavorofinsurancereform.” Althoughtherewereafewpeoplewhowereinfavoroffullcoverageinsurancebythegovernment,theoverwhelmingmajoritysaidtheywereinfavorofhealthinsurancemarketreform.“Atfirstitwashardtogetpeopletostop,butthenthosewhodidstop seemed definitely concerned about thefutureofthehealthcaresystem,”said Hanas. “It’s imperative that we providebetterpreventativecareforchildrenandyoungfamilies.ItwasagreatexperienceandIwassogladthatIparticipated.”

State News

Iowa State Fair

AMA Launches “Voice For The Uninsured” CampaignInAugust,AMAlaunchedathree-yearcampaigntospuractiontocoverAmerica’s uninsured. The “Voice For The Uninsured” campaign is timed in conjunctionwiththe2008electioncycle,andwillbringahumanfacetoaproblem that affects millions.

• 2007: The first year of the campaign focuses on efforts to talk with voters and candidates about the problem of the uninsured and the AMA’s solu-tion. The first phase will have a special emphasis in Washington, D.C. and earlyprimarystates(Iowa,N.H.,S.C.).

•2008:Yeartwoofthecampaignwillexpandnationallyandwillfocusoninfluencing Americans to vote with the issue of the uninsured in mind.

•2009:ThethirdyearofthecampaignwillfocusonurgingmembersofCongress to pass legislation to fix this national problem.



AMA Alliance introduces logo wear

Showyourpride,shareyourviewonbehalfofthefamilyofmedicine!

ChecktheAMAAllianceWebsitefor:

•WhiteAdultT-Shirts(S,M,L,XL),$10•HoodedGreySweatshirts(S,M,L,XL),$25•Women’sU-NeckWhiteShirts(S,M,L,XL),$25•BlackDuffelBags,$20•Baseballcaps(stone,green,dandelion,black),$10

Pickupat-shirtforyourself,aduffelbagforafriendorabaseballcapforaneworpotentialmember.Logowearitemsmakegreatgifts!

VisittheAllianceWebsite,www.amaalliance.org,fordetailsandorderinginformation.


ama alliance today september/october 2007

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