Sunday, September 30, 2007

Milestone for EverythingHealth

We bloggers love visits. I am amazed that Everythinghealth has had over 10,500 visits since I started tracking in about March! Readers come from all over the globe..Dubai, Ireland, Spain, Australia, Brazil, Canada, UK, China, Indonesia, Denmark, Mexico, Germany, France, Egypt, Italy, Thailand, India, Israel, Hungary, Philippines, and across the U.S. (So sorry if I left your country out.) I am just fascinated by the web and the instant and easy access to information, friends and knowledge.
Thank you for visiting and please return often.

Colorectal Cancer and Coronary Artery Disease

A landmark study was released in Jama last week that showed a strong correlation between colon cancer and blockage in the coronary (heart) arteries. It is becoming known that colon cancer and Coronary Artery Disease (CAD) have the same environmental risk factors. Diabetes, smoking, hyperlipidemia, sedentary lifestyle, high-fat, low fiber diet and hypertension are significant health hazards world wide.

This study did colon cancer screening (colonoscopy) on over 600 patients. The three groups studied were:
General population (control group),
People with no CAD and
People who had Coronary Artery Disease.

The researchers found 34% of patients in the CAD positive group had colon cancer. In the age and sex matched general population, only 21% had a colorectal cancer. And only 18% of patients without CAD had a colon neoplasm.

This is a remarkable finding. Both colorectal cancer and CAD probably develop from chronic inflammation. Inflammation is now being recognized as an important cause of atherosclerosis (CAD) and colon cancer.

We have much to learn about what causes inflammation and how to prevent it. Until we have the evidence, I recommend a daily low dose aspirin, absolutely no smoking and Omega 3 FFA supplements along with oatmeal for breakfast. Stay tuned for more scientific breakthroughs as we learn more about inflammation and its affect on the body.

Friday, September 28, 2007

Insurance Profit - Yes There is Blame

Health Affairs had an analysis of why hospital bills are so high and said you could "Blame the Paperwork". Anyone in the health industry could have told you that! The amount of waste and expense in getting the bill paid by the insurance company could cover the uninsured in the U.S.

The study, funded by PNC Financial Services Group, contends that about one-third of all healthcare costs can be attributed to administration—an unacceptably high share, according to the 1,000 consumers who were surveyed along with 200 hospital and insurance company executives. Here is what they found:

  • Hospital executives reported that one in five claims submitted is delayed or denied and 96 percent of all claims must be submitted more than once.
  • Hospitals that do not use electronic billing or claims submission processes reported resubmitting a claim 11 times or more, or nearly four times more than those hospitals using electronic processes.
  • Insurance executives surveyed say they go back to hospitals twice, on average, to get all the information needed to pay a claim.
  • Nearly a quarter of consumers reported having had a legitimate claim denied by their health plan, and one in five ultimately paid the claim out of pocket.
Hospitals and doctors spend millions TRYING to get claims paid.

Let me break this down into its simplest form. Insurance companies are for-profit, wall street conglomerates. There is no mystery why the largest buildings in any metropolitan city are insurers. They have posted record profits for years. They make their money by taking in more money than they spend on health care. Denial of claims, rules that no one understands, underwriting only healthy people and then dropping them when they get sick all means profit. If they can delay paying claims for several months, billions of dollars are the "float" that they keep. For smaller claims, like doctors bills, we just give up and eat it because we can't afford to keep submitting claims for $50.00. Patients give up too. Wall street loves the insurance industry... America loves them....Politicians love them.

Paula Fryland, executive VP of PNC's national health care group said:
“I don’t think there’s anyone to blame, per se; it’s a reflection of the complexity of the payment relationship between insurers and hospitals. The benefit we have in our system of choice and customization is part of what makes things more expensive.”

Wake up, America! There is plenty of blame! This system of choice and customization provides little benefit at great cost. The major benefit goes to Wall Street. I love profitable companies also. I just don't want the profits to come from my health care dollar. I want that dollar to pay for health care...either mine or my fellow American.

Thursday, September 27, 2007

Top 10 Prescribed Drugs

Patients are always complaining that they take so many prescription drugs. Most drugs people take are not treatment but are preventing disease and early death. That's why they are taken chronically. (and are such a financial boon for the pharmaceutical industry). The top 10 drugs prescribed by Internists in 2006 are:

1. Lipitor (a statin for high used for diabetes too)

2. Lisinopril (an Ace inhibitor for high blood pressure and diabetes and congestive heart failure)

3. Hydrocodone/APAP (a narcotic pain know it as Vicodin)

4. Atenolol ( a beta blocker used for high blood pressure, congestive heart failure and migraine)

5. Hydrocholorothiazide (a diuretic mainly used for high blood pressure)

6. Levothyroxine (a thyroid replacement)

7. Furosemide (a diuretic called Lasix used for congestive heart failure)

8. Norvasc (a calcium channel blocker used for high blood pressure and angina)

9. Metformin (used for diabetes and polycystic ovary called glucophage)

10. Toprol XL (a beta blocker used for high blood pressure and congestive heart failure)

I was surprised there were no antidepressants or antianxiety pills on the list. Ten years ago, Valium would have been there. Does this mean we are getting more mentally healthy as our vessels and blood pressure deteriorates?

Gloves for Garbage Pickers

The next time you feel like complaining because you have a crummy boss or benefits are being slashed...think about work conditions in Delhi. This eye opening glimpse of the life of "ragpickers" from the New York Times is enough to silence any whiner.

"More than 95 percent of New Delhi has no formal system of house-to-house garbage collection, so it falls to the city’s ragpickers, one of India’s poorest and most marginalized groups, to provide this basic service. They are not paid by the state, relying instead on donations from the communities they serve and on meager profits from the sale of discarded items. On Oct. 2, Gandhi’s birthday, the Delhi state government will make a small but significant concession. In response to pressure from a ragpickers’ union, it will supply about 6,000 with protective gloves, boots and aprons." They would prefer earning more than $38/month so they can feed and clothe their children.

Wednesday, September 26, 2007

Cigarette Additives

It drives me crazy that tobacco farmers are subsidized by our government and that tobacco makers have targeted other countries to pick up the slack of decreased cigarette smoking in the United States.

The 2007 farm bill was passed in July and continues the 75 year tradition of tobacco subsidies. As the tobacco farmers line up for government handouts, the Wall Street Journal reports:

"Nationwide, the tobacco crop has been rebounding. Today there are 355,000 acres under cultivation — still down from the 408,000 acres in 2004, but on the rise. Some farmers reinvested their buyout cash in their tobacco operations. In big tobacco-producing states such as Kentucky, and in smaller ones like Wisconsin and Pennsylvania, many tobacco farmers are enjoying renewed prosperity. Tobacco production in Pennsylvania has more than doubled since 2004. In Illinois, production has gone from practically none to at least 1,000 acres."

At the same time as our tax dollars are used for growing tobacco, scientists from UCLA published an article in AM. J Public Health that showed more than 100 cigarette additives have pharmacological actions that are detrimental to human health. Some of the additives camouflage the odor of cigarette tobacco smoke and enhance nicotine delivery. Other additives contain chemicals that can make it easier for cigarette smoke to penetrate the lungs - possibly increasing the addictiveness.
They even found chemicals that anesthetize the smoker and make it easier to avoid coughing.

Enough is enough. Cigarette smoking is the single most preventable cause of premature death.
Cigarettes kill more Americans than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined.

Although 70% of smokers want to quit and 35% attempt to quit each year, fewer than 5% succeed. The addictive properties of cigarettes rival cocaine and heroin.

It is a schizophrenic society that subsidizes tobacco growing, has no oversight or regulation on what goes into cigarettes and then cries about the rising cost of health care when those very cigarettes are the main cause of cancer and death. Hmmmmm.

Monday, September 24, 2007

More Maasai Health

Our Maasai visitors have left and we feel an emptiness in our home. They were so loving and warm and touch is a huge part of their culture. We really feel blessed to have experienced these wonderful, musical people from Kenya and we hope to visit them there when we can.

The Maasai's are a tribe of 350,000 found in Kenya and Tanzania. They are semi nomadic cattle herders and warriors who now live on the driest and least fertile areas because of less and less available land. Polygamous, the men can have as many wives as they can afford. Each wife has her own hut made of grass, mud and cattle dung and she and the children care for her own herds of cattle.

Girls are circumcised at about age 13 and married at puberty to an older male. Young men are circumcised in a ceremonial ritual at age 18 and they reenter society as men. They are not eligible for marriage, however, until they are 28-35 years old. It is a male dominated society and women do most of the work.

The Maasai healer is called a laibon and is known for his herbal remedies and rituals that absolve social and moral transgressions. Access to western health care is rarely available or affordable for the Maasai.

The Maasai have a rich culture and history and have managed to preserve it despite the encroachment on the land. Spending time with them actually brought a quiet peace into the home and they were the most gracious and thankful guests. They have a philosophy that we could all benefit from that is not to put off saying something or hugging someone because you don't know if tomorrow will come. They truly seem to live in the moment and "do it now" is not just a saying but a way of life.

For more information on Friends of Sironka Foundation click here

Sunday, September 23, 2007

Post Secret-again

Its Sunday and for anyone who missed the link to Post Secret website, I wanted to give it again. Each week the secrets change so check back every sunday for the new ones. Some are pretty heartbreaking!

Saturday, September 22, 2007

New FDA Approvals/Medical Updates

Readers of Everythinghealth like to be on the cutting edge so here are so here are some new Food and Drug Administration (FDA) approvals.

Home-Based Fertility Screening:
The first at-home fertility screening test for men and women enables couples to assess fertility earlier. the screening kit includes male (motile sperm) and female (follicle-stimulating hormone) tests proved 95% accurate. It is cleverly called "Fertell."

Lipid Profile Device: CardioChek PA is a diagnostic devise that can measure a patient's lipid profile in the office or waiting room in less than 2 minutes. (you can buy it for home use but be prepared to spend $149 for the machine, plus cost of various test strips, shipping, etc).

Estradiol Spray to Treat Menopause: Evamist has been approved by the FDA for the treatment of menopause symptoms. The spray is delivered in metered doses. ( I have been unable to find any information on this and I am not aware of any physicians prescribing it. Please comment if you know more)

First Artificial Cervical Disk: The FDA has approved the Prestige cervical disk for treating degenerative disk disease. It is used to replace the impaired natural disk during surgery and would fusing the bones after removal of the diseased disk.

Urinary Flow Measuring System: The FloPoint Elite Uroflow System measures and records a patients pattern of flow, allowing a physician to assess bladder function and patterns. It is installed in a standard toilet, with no awkward chair and uses digital wireless technology. (I am not sure what technology this replaces but the standard toilet part sounds good)

Smart Brace for Stroke Victims: The e100 NeuroRobotic System has been cleared by the FDA for marketing as a portable elbow brace. The devise is designed to help people relearn how to move paralyzed upper limbs. When a patient's electrical muscle activity signal fires in response to attempted movement, the devise senses the signal on the skin and reinforces the normal movement.

Thursday, September 20, 2007

Maasai Medicine

The next best thing to travel and experiencing something new, is to have travelers come to you. I have been fortunate to be able to host a Maasai Cultural Dance troupe in my home this week as they perform in my town. Their mission is to uplift the villagers in Kenya, Africa by selling their beads and art and earning money that they take back home. That money is used for education and a better life for their families. Seleina and Sironka, the group leaders, are my guests and they both speak English. The difference between their lives in a small village in Maasai country and my life in the medically sophisticated U.S. struck me tonight as I questioned Seleina about health care in Kenya.

I attended a quality meeting this morning where we discussed a sentinal event. A sentinal event is something so rare, so unusual, that teams of professionals are brought together to evaluate it, dissect the components and institute processes to prevent it from ever happening again. This sentinal event was the death of a pregnant woman. In the U.S. that is such a rare event that it shocks the entire hospital. In Kenya, childbirth is a dangerous undertaking for a woman.

The Maasai village that Seleina comes from doesn't have a hospital close by. If they cannot make it to a distant clinic, childbirth takes place at home and the mortality rate is high. Their huts are made from mud and dung and have dirt floors. Pregnant women are told to eat very little so they will have small (easier to deliver) babies. Of course this contributes to anemia and poor health in both mother and baby.

I thought about our moms- to -be with prenatal vitamins and ultrasounds and realized how lucky modern Western women are to have the benefits of excellent health care and technology. We forget that at the turn of last century, the most common cause of death for women was childbirth. Sadly, that is still the case in many developing countries today.

The Maasai culture is wonderful and the people are beautiful with the same dreams, ambitions and love of their children as we have. I can't wait to learn more about health in their Country when we talk over dinner tomorrow evening.

Tuesday, September 18, 2007

The Hospitalist - What the heck is that?

The average American doesn't know that a revolution has occurred in medicine and there is a new type of doctor called a "Hospitalist". It is the fastest growing branch of medicine and there are 20,000 doctors today that practice only hospital medicine. Most hospitals in America employ Hospitalists and if you are admitted to a hospital, it is likely that he/she will be your main attending doctor...not your primary care physician.

The Hospitalist is a doctor with Internal Medicine or Family Practice training, who is always on site. They are available to admit patients, manage care during the day, review tests, change medication, and respond to the patient and nurses instead of rushing in at 7 AM and then back to the office to care for a full day of patients. Hospitalists don't have an office practice, nor do they follow patients once they are discharged.

Hospitals like them because they reduce length of stay and follow standard protocols of care. That should lead to improved quality but large studies to prove that need to be done.
Young doctors are flocking to this type of practice because they have regular, set hours with no "on call". They get a salary plus benefits and don't have to hassle with billing insurance, getting paid or running a practice.

But what about the patients? Many patients are shocked that their own doctor is not the attending (although many do still visit their patients in the hospital). There is concern that care will be fragmented and the Hospitalist won't have the full past history. Despite these fears, patients that experience Hospitalist's care seem satisfied and get used to the idea pretty quickly, especially if there is good communication between their primary care physician and the hospital doctor.

There is no going back. Hospitalists are here to stay and the doctor who handles both the office and the hospitalized patients will be few and far between. I personally found the mix of hospital and office practice rewarding and interesting. I enjoyed the interaction with nurses, respiratory therapists, dietitians, Xray techs and specialists when I made hospital rounds. I understand the driving forces that created Hospitalists ($$$). At the same time, I feel sorry for young Internists who will not experience the joy of practicing the full range of patient care.

Saturday, September 15, 2007

Guest Post-Hangovers 101

Hey, Everythinghealth readers! Check out the blog Med-Friendly. I wrote a guest post on "Hangovers 101" that is there for the reading.

Friday, September 14, 2007

Five Must Do's For a Sick Loved One

When a loved one is sick, we often feel totally helpless and caught up in the medical world. If people only knew how important their role as caregiver really is. Credit goes to Elizabeth Cohen, CNN, for these wonderful tips on how to fight for and protect a sick loved one.
  • Don't be afraid to intervene: If you see something going on that strikes you as wrong, say so. A medication that you've never seen before, a dressing that remains after a doctor said it would be removed, IVs that should be given on a regular schedule. It's OK to push and not accept the first answer.

  • Ask Questions until you understand the answer: If the doctor says surgery is needed and you don't understand why or when or how...ask. If explanations are given in terms that make no sense..push until you understand.

  • You know things that the doctors don't: You know if your loved one is in pain, has been bleeding longer than the doctor thinks, is shy and won't talk or hundreds of other facts that the medical folks just can't know. Share might be important to healing.

  • Temper your loved one's enthusiasm for quick fixes: Pain and anxiety can affect the way a patient hears the doctor. It is OK to ask for a 2nd opinion, look at alternative treatments or just stop and discuss. Be the advocate with the clear mind.
  • Scope out the nurses: The nurses are the ones that see it all. They know the details of tests, timing and the ins and outs of the complicated hospital environment. The nurse can often interpret things for you if you didn't follow rule #2. Nurses are the patient's second best advocate after you, so partner with them.
The patient without a significant loved one at their side is at a clear disadvantage. I am always happy to see family gathered around when I round on a hospital patient because I know we are all working together for a common goal.

Monday, September 10, 2007

Primary Care Doomed - what does it take to get paid?

Most primary care doctors are running a small "mom and pop" business and any business will fail if payment is not received. A review of "ageing reports" (accounts receivable) can be eye opening for the doctor. Thirty-60-90 days past due can be a financial disaster. But what about bills that are not paid for over a year? It is not uncommon for active patients who get prompt return phone calls, easy access when needed and seem to be very happy with the service to just ignore the bill.

Seeing this list of patients who just won't pay their bill is usually a shock for the doctor. All of these statements were first sent to insurance companies. The insurers delayed as long as possible (60 days or more) and either made a partial payment or paid zero because it was applied to the patient's deductible, or the patient wasn't even insured at that time.

The patient received an explanation of benefits (payment or lack of payment) from their insurer at the same time the medical office received it. Bills are then sent to the patient for the balance due. Most billing services (which is part of the doctors' exorbitant overhead) sends a statement month after month after month. It is a rare doctor who would send someone to collections.

These amounts are small for a general internist. The amounts due range from $21 to $455 (that is obviously multiple visits over time). When physicians see a patient, they do not usually know their account status. A good doctor DOESN'T WANT to know and that may be one reason many primary care physicians are struggling financially.

Available primary care physicians are few and far between. Many are not accepting new patients . I am asked for referrals all the time and I am hard pressed to know who would take a new patient. In the San Francisco Bay area, fewer and fewer primary care doctors are accepting insurance, but instead are asking for payment at the time of service. As others start looking at their accounts receivable, they will be doing the same.

Saturday, September 8, 2007

Katrina Nursing Home Owners Aquited

Justice was served when the jury acquitted the operators of St. Rita's nursing home in New Orleans, on 35 counts of negligent homicide and 24 counts of cruelty to the infirm today. The Manganos, age 64 and 67 have run that home for 20 years and have been through many hurricanes. Katrina was different. The water surge and levee break caused water to rapidly rise and evacuation of all the bed bound and demented patients was impossible. The Manganos managed to rescue 24 frail patients but the others drowned.

Of the 1400 Katrina deaths, one hundred forty patients died in nursing homes and hospitals. As a medical volunteer, I saw the destruction and experienced the human drama after Katrina. I know first hand of the terrible conditions from the storm and aftermath. St. Bernard's Parish was one of the worst hit. Mile after mile was silent, oozing water and mud with only the sad, sick animals showing signs of life. The graveyard crypts were open, with caskets flung around, accentuating the devastating scene.

I was at St. Rita's nursing home in St. Bernards Parish for body recovery, acting as medical support for the search team. The bodies had been there for over a week. We did not know ahead how many bodies were there, and it was a secret mission because the press was already blasting the governor for the lack of response. They wanted this to be handled without reporters, but we were photographed from a helicoptor above. That photo ran in Time magazine but no-one knew what we were experiencing on the ground.

Even with the National Guard on the scene a week after the storm, communication was zero and organization was sketchy. People looked to me as the expert of our recovery team and I had no working phone, no map of the area, no GPS or knowledge of how to get help. A local policeman flagged our team down and begged us to look inside his parent's flooded home because they were missing. We found their bodies with 2 neighbors bodies, wearing life jackets, amid the rubble in the home. The policeman collapsed with grief and the medical treatment needed was aid to his soul. A member of our team collapsed from dehydration in the sweltering heat. We transported the bodies to the makeshift morgue located in another city and underwent decontamination ourselves. We ended that long day at 2:30AM.

No one should point fingers at anyone who was a victim and caught in this storm. Evacuation was not possible for thousands of people. They did not have the transportation or the ability, during a rapid flood, to evacuate bed ridden people. The Manganos did not abandon their charges and I can only imagine how difficult and frightening that awful night must have been.

Thursday, September 6, 2007

ADHD and Food Additives

Parents around the world can now say "See, I told you so!" A study released in Lancet and reported in the New York Times has shown a possible link between attention deficit hyperactivity disorder (ADHD) in children and common food additives.

This was a well run study that focused on a number of food colorings and the food preservative "sodium benzoate", that are found in many foods. Children ages 3, 8 and 9 were given placebo drinks (no additives) and drinks that contained the additives. They controlled other aspects of their diet so they did not eat other preservatives. They also controlled the dose so it was equivalent to one or two pieces of candy a day. Parents and teachers were involved in rating the behavior for inattention and activity and no-one (including the researchers) knew which group was which. This is called "double blind" and is the best form of research.

They found that the kids who ingested the additives were more hyperactive and had lower attention spans. They could not pick out which additive (s) was the culprit but the results were pretty conclusive.

I have long wondered if "red dye #22" and other strange names found on food labels was a problem. Many parents have thought that sugar increases hyperactivity and prior studies have shown that sugar is not the problem. Sugar is natural, but preservatives, colors and additives are not, and they are found in so many products, including candy, cookies, crackers, canned foods and juices. If this is a link to the exploding incidence of ADHD we are on to something really important.

Congrats to the Brits Food standards Agency for for conducting this study. Why has it taken so long?

Wednesday, September 5, 2007

Why Are Americans So Fat?

In just one year, a new study shows, obesity rates have shot up across the country.
Why are Americans so fat? Here are my reasons...feel free to add your own.

  • 22% of Americans did not do any physical activity in the past month.
  • Our government subsidizes high fructose corn syrup. It is cheap and in everything!
  • No one cooks anymore. Fast food is fat food.
  • Kids have too many choices. (remember when mom cooked something you didn't like? You picked at it and got away from the table fast)
  • We have huge portions. Rent the movie "Supersize Me" and you will be shocked.
  • Food is available everywhere...all night markets, fast food on every corner, snacks at every office, cupcakes and candy at every holiday/school birthday.
  • We eat too fast. In other countries they chew and relax. We work.
  • Stress hormones affect metabolism. We need to chew and relax.
  • Cheap food is fat food. Poverty and obesity go hand in hand in America.
  • TV, Computer games, Play Station.
  • Kids are restricted from playing freely outdoors.
  • We eat more than we burn.

Tuesday, September 4, 2007

Plain Soap Kills Germs as Well as Antibacterial Soap

I was surprised at the results from researchers at University of Michigan School of Public Health that found the effectiveness of plain ole' soap is as good as antibacterial products at killing bacteria.

Soaps, detergents and other "antibacterial" products that contained triclosan were no better than plain soap for preventing infections. Washing your hands is very important for preventing the spread of infections, especially after using the toilet (duh!), changing a baby or handling raw foods, but plain soap does the trick.

Apparently these results are not new news. An FDA advisory panel looked at the effectiveness of antibacterial products in 2005 and concluded regular soap was just as effective. Who knew?

When to Use Urgent Care

We all know that Emergency Departments are over-crowded with long waits and exorbitant fees.  Free standing Urgent Care is a great solu...