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Showing posts from October, 2007

The End of Polio

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A medical student today will go through their entire career without ever seeing a case of polio. The polio virus was feared throughout the early 20th century, leaving millions paralyzed or dead. During Summer and Autumn, polio epidemics spread human to human with this highly contagious disease. In the 1940's and 50's, negative pressure ventilators called the "iron lung" were used to support patients with paralyzed respiratory muscles. In 1952 the worst polio epidemic struck the United States, with 58,000 cases and 3,145 deaths. Over 21 thousand victims were left paralyzed.

By 1964, the oral polio vaccine, developed by Albert Sabin, had become the recommended vaccine. It was easy to administer and large populations could be vaccinated.

The effort to eradicate polio was launched in 1988 and involved the World Health Organization, Rotary International, the CDC and UNICEF. Through everyone pulling together, more than 210 polio endemic countries were targeted for ch…

It's Post Secret Day

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Every Sunday the new Post Secrets are online. They only last a week. Don't miss out at this sad, amusing, wonderful look at mankind.

MRSA- it's tiny microbes

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With all of the continued interest in MRSA (methacillin resistant staph aureus), it is a good time to remember just how bacteria work. According to author Bill Bryson..."if you are in good health and averagely diligent about hygiene, you will have a herd of about one trillion bacteria grazing on your fleshy plains-about a hundred thousand of them on every square centimeter of skin. You are for them the ultimate food court, with the convenience of warmth and constant mobility thrown in. By the way of thanks, they give you B.O."

Trillions of Staph Aureus microbes live on your skin and in your nasal passages. These bacteria are not harmful, and in fact, we depend upon them, living in harmony with other bacteria to keep our bodies and our planet in check. We think because we have invented antibiotics and disinfectants, that we can wipe out bacteria. What we have done, however, is just allowed them to evolve into another type that is resistant to our drugs and become penicill…

Rate Your Doctor

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I think the internet will have a huge impact on patient satisfaction of how they are treated by doctors. The idea of internet sites that rate doctors and hospitals has been around for about 5 years. In the past the sites have been difficult to view, some cost money and they were not user friendly. But like anything new...it may now have reached a tipping point.

I logged onto Ratemd.com and was surprised to see how easy the site was to navigate. It was free and you could look up doctors by name or city. I looked for my name...not there. But I found ratings on many of my doctor colleagues and 12 ratings on one of my "larger than life" medical school pals who now practices in Southern California. Wow he better make some improvements. It sounds like he is running a factory and the patients are none too happy. With a 5 point scale (5 being excellent) patients could rate doctors on punctual, helpful and knowledgeable and leave comments.

I found only a few surprises. In any…

Patient Safety- Run the OR Like a Jet Plane

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We all know about the poor patient who goes in for a right kidney operation and ends up having the "good" left one removed instead. Or the patient with the allergy who is given the wrong anesthesia and has a reaction. Or the patient who is given the wrong blood type. These things happen despite the fact that doctors and nurses are doing their very best to heal under really tough circumstances.

I saw a film at a conference that really impressed me about how we need to fundamentally change how we address patient safety and live up to Galen's dictum of "primum non nocere" ("first do no harm.")

The film showed an operating suite, with the scrub nurses, anesthesiologist, surgeon, medical student, radiology tech all gathered around the patient lying on the operating table. Instead of just starting the operation, they stopped for a required "time out". The protocol was rigid.

The circulating nurse identified the patient by name, birthdate, age and…

Transparent Pricing for Patients

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There is a big push toward having patients be smarter consumers of health care as a way to control costs. Employers are pushing for medical savings accounts (where the patient has a pot of money they spend on health care or just save) and more and more insurance products have high deductibles and more cost sharing by the patient. The simple way of explaining it is that if someone else is paying the bill (insurance, medicare, the government) people will just use lots of care and testing and medications and procedures and have no regard to cost.

In a normal market, lower cost, high quality products would prevail. The medical market should operate that way but it doesn't because the incentives aren't aligned. The person receiving the benefit ( the patient) is often far removed from the true cost.

The only way a true market could work is if the consumer (patient) KNOWS WHAT SOMETHING COSTS! Here is the rub. It is near impossible for a patient to find out ahead what the cost of a tes…

Surgical Model

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In my medical training, oh so many years ago, we learned from cadavers. While this was a good way to learn basic anatomy, the physiology of how the body worked was a slower process. Thanks to Unbounded Medicine for this look at the way students can learn now. This reproduction of a patient was crafted with animal organs that really give the student a much better idea of how the body functions.

MRSA - It's preventable

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Everywhere I turned today, I was engaged in discussions about methicillin resistant staph aureus (MRSA) and tonight I read a new article in JAMA that says it is twice as prevalent as we thought.

MRSA is a common skin bacteria-Staphylococcus aureus-that has become a "bug on steroids" and is resistant to penicillin, methicillin and other drugs that used to kill it flat. It has developed over time and 85% of infections are associated with hospitals and long term care centers. When it enters the skin barrier through incisions or IV lines, it can cause serious internal infections and is a leading cause of death.

Staph aureus is found in the nose and respiratory tract and healthy people can be carriers. It can live on clothing and curtains and (I've heard but not verified) that in England they are prohibiting physicians from wearing ties because of possible contamination.

MRSA infections are preventable and the bacteria is killed by topical alcohol.We've known that hand was…

Healing Environments

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While the housing market has bombed, new hospital buildings are the rage in California due to a law that says they need to be seismically (earthquake) safe. As hospitals are planning the hospital of the future, many are using architectural design to reduce stress and promote safety and healing.

What type of building promotes safety and healing? We know what doesn't work. I've practiced in hospitals where the beds are so close together I could examine two patients at once without moving my feet. One wall mounted TV services two patients, so if you don't want to watch another episode of "Cops" while you are recovering from surgery, you're out of luck. And what about those bed trays on wheels that hold your food, your medication, your cards from relatives and your personal grooming supplies all together... clutter does not promote healing or good sanitation.

Most hospitals are hip to the fact that "noise" is a problem for patients and they try to keep …

Plastics and Chemicals That Can Harm

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The chemical, bisphenol-A (BPA), is used to produce polycarbonate plastic and epoxy resins and is found (get this!) in water bottles, baby bottles, food containers, compact discs and dental sealants. The chemical can leach into foods, be inhaled or enter by other routes and the US Centers for Disease Control and Prevention found this chemical in the urine of 95% of people they sampled. BPA is an estrogen mimic and may interact with estrogen receptors.

Numerous animal studies have been conducted for years that link BPA with diseases and they have identified a mechanism where BPA exposure in pregnant rats causes genetic changes that persist through the life of the offspring. They also found neurological effects of BPA exposure that caused the mother rat to groom the pup less. The findings were species specific, but they involve areas of the brain that play a role in hormonal regulation and sex-related behaviors across species.

The complex factors, both environmental and genetic, tha…

Withdrawl of Kid's Cough Medicines

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McNeil Pharmaceutical has stepped up to the plate and done the right thing by voluntarily withdrawing a number of cough and cold preparations that may be harmful to kids under the age of 2. Recent findings show these medications can be overused by parents and there are no safe guidelines for tiny tikes and these preparations. McNeil has begun by informing physicians of the following:
We have decided to voluntarily withdraw the following over-the-counter (OTC) infant cough and cold medicines from the market:
Concentrated Tylenol® Infants' Drops Plus Cold
Concentrated Tylenol® Infants' Drops Plus Cold & Cough
PediaCare® Infant Dropper Decongestant
PediaCare® Infant Dropper Long-Acting Cough
PediaCare® Infant Drops Decongestant (containing pseudoephedrine)
PediaCare® Infant Dropper Decongestant & Cough
PediaCare® Infant Drops Decongestant & Cough (containing pseudoephedrine)

We believe the decision to voluntarily withdraw these products may help to reduce these instances of m…

Thought for the Day

Optimism is an intellectual choice.

Sport Concussions

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One of my most "googled" blogs was "A bump on the head". Falls and head injuries are common and an estimated 300,000 sports-related concussions (also known as mild traumatic brain injury) occur annually in the United States. Researchers estimate that 63,000 of those occur in high schoolers playing football.

The tough thing about concussions is that there is no marker or test to know if a person has one. With new technology like functional MRIs (fMRI), doctors can see changes in brain function and link those changes to the recovery time needed for injured athletes. With a concussion, fMRI identifies abnormal hyperactivation in specific brain regions that control cognitive process, such as memory. They can provide the first understanding of how a concussion affects the brain.

fMRI machines are scarce and found only at academic medical centers and the cost for a scan can run up to $1200. Until the technology becomes more common, we are left with arbitrary guidelines…

Medicare Drug Plan - Profitable to Insurers

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The New York Times has an article that is no surprise to physicians and pharmacists who care for patients. Guess what? The wonderful Medicare Drug Plan for seniors has turned into a cash cow for insurance companies that administer it. Duh! Since when do Insurers ever do anything with the government that doesn't fatten their pockets?

Audits, conducted by the Department of Health and Human Services found serious compliance problems in deceptive marketing practices, denial of claims and handling of appeals. Sales agents sold products that were not really available, formularies did not cover needed drugs and there was no way for a patient or doctor to appeal or even get someone to answer the phone. Claims were denied and people were told they were not enrolled even though they produced cancelled checks. Wellpoint, one of the nations largest insurers, has a backlog of 354,000 claims. Gee, they are in the insurance business and can't handle claims? Isn't that their on…

Doctors and Email

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I tried to phone a patient last night with the results of her bone density test. She wasn't home and the thought of playing phone tag for the next few days was not appealing. I asked her husband for her email address and emailed her the results with my recommendations. Mission accomplished!

Everyone emails. My son chats online with all of his friends together every night. You can order shoes online (Zappos is great), do banking online, make reservations online, even hire gardeners online...but you can't communicate with your physician online. There is a web revolution and medicine is still in the last century.

A 2002 Harris poll found 70% of patients wanted online access to their doctors and 40% would pay for it. Although it is now 2007, not much has changed. Medicine is astonishingly behind the rest of the world. From the physician view, here's why:

Doctors want to reduce their cost of business and their staff time. They see email as a new service that will not be reimbur…

Thunderstorms and iPods

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Letters have been circulating in the New England Journal of Medicine about the potential dangers of iPods (and MP3 players) and their ear wires attracting lightning to strike during a thunderstorm. An initial report of a jogger wearing his iPod and being struck by lightning came from Vancouver, BC. The patient did not lose consciousness, but he had amnesia, perforated eardrums and a fractured mandible (jawbone) after the lightning current struck him. Was the iPod to blame?

There is no evidence that a metal or electronic apparatus carried or worn on the body makes a person more attractive to lightning. Rocking along to an iPod may prevent the user from hearing thunder. That is a danger because there is no place outside that is safe when thunderstorms are in the area. Under a tree is the worst place to be and when you hear thunder you should not be outside at all.

It is possible that the iPod wires actually conducted electricity away from the patient's ears and away from his heart whe…

Give an Hour - mental health for vets

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Just when I feel so discouraged about the direction our country is headed, I get a lift by learning about a new organization that is developing a national network of mental health professionals that will provide free care for returning Iraq and Afghanistan vets and their families.

"Give an Hour" is a non-profit of volunteer mental health professionals across the United States that will donate an hour a week of continuing care, support and treatment...free to the vet or his family. They provide easy access to skilled professionals for people affected by war.

Our combat vets are coming home with depression, anxiety, post traumatic stress disorder and feelings of disassociation. It can be a surreal experience to re-enter American life and carry the horrors of war inside when everyone else is going about life as usual. Many of these men and women fail to seek or receive appropriate care and their families are also struggling with the changes war has brought.

According to Medical N…

How to Interpret Medical Studies

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We are bombarded with news of medical breakthroughs every day. How can you know what studies are valid and important, and which ones are just fluff? Here are some ways to tell the difference:
How many people were in the study? The more the betterWho were the subjects, researchers and sponsors? The funding source of the study is important and might change the motives. Do the researchers have credentials? Are the subjects like you? A study of Tibet Nuns might not be as meaningful.What was studied? The best studies look at outcomes...such as rates of heart attack or stroke. Other studies focus on test results. Outcome studies are the hardest to do, but the results are the most meaningful.
Meta-analysis: The researchers pool many study results to analyze information from hundreds or thousands of patients.Case controlled study: Compares cases (people with disease) to controls (people without disease) to see why the disease occurs.Single randomized controlled trial: patients are divi…