Huh?

Thanks, I'll pass!

Pistachios Cause Salmonella Fear

The FDA is advising us to stop eating all foods containing pistachios because of the possibility of salmonella contamination.

Two cases of gastrointestinal illness have been reported and may be from eating pistachio nuts. Because of the recent outbreak of Salmonella related to peanuts, the largest producer of Pistachios is voluntarily recalling a portion of the 2 million pounds of nuts it has produced since last fall.

California is the second-largest producer of pistachios in the world and Setton Pistachio of Terra Bella Inc ships pistachios to other companies that use the products or repackage them for consumers. Kraft Foods, who produces Back to Nature Nantucket Blend Trail mix detected salmonella through routine product testing. Kraft receives the pistachios from Setton. The grocery store Kroger Co. also recalled bagged pistachios because they receive bulk from Setton.

Setton Pistachio shipped 2000 lb bags to 36 wholesalers across the country since September 1, 2008 and many of those nuts were used in ice cream and baked goods.

Expect to see the recalls intensify over the next few weeks. California public health officials are testing samples now and testing at the plant. The results are pending.

Therapists Try to Cure Homosexuality

A study from the BMC Psychiatry showed 17% of British therapists still try to "cure" gay, bisexual and lesbian patients from homosexuality and try to help them become heterosexual.

It is hard to believe that in 2009, with all of the evidence that shows attempting to change a person's sexual orientation is not only ineffective but can be psychologically damaging, this type of practice persists. The "gay cures" that have been reported in the literature have been thoroughly discredited. That a trained therapist would be so out of touch with current research is malpractice.

In the 1970s, "aversion" therapy was in vogue. This involved using electric shocks when presenting a patient with a same sex erotic image to try and create a sense of revulsion. Those techniques belong with other archaic treatments such as lobotomy as a sign of psychiatry failures.

The American Psychiatric Association's website notes in part that, "There is no published scientific evidence supporting the efficacy of "reparative therapy" as a treatment to change one's sexual orientation. More importantly, altering sexual orientation is not an appropriate goal of psychiatric treatment..." It goes on to say, "The American Psychiatric Association opposes any psychiatric treatment, such as "reparative" or "conversion" therapy, which is based on the assumption that homosexuality per se is a mental disorder, or that the patient should change his/her homosexual orientation."

For a comparison of the divergent beliefs on homosexuality where the most conservative (religious) views of homosexuality are compared with progressive views based on science , go to Religious Tolerance.

image from Post Secret

98% of Babies are Manic-Depressive

Breaking news from The Onion:

March 23, 2009

NEW YORK—A new study published in The Journal Of Pediatric Medicine found that a shocking 98 percent of all infants suffer from bipolar disorder.

"The majority of our subjects, regardless of size, sex, or race, exhibited extreme mood swings, often crying one minute and then giggling playfully the next," the study's author Dr. Steven Gregory told reporters.

"Additionally we found that most babies had trouble concentrating during the day, often struggled to sleep at night, and could not be counted on to take care of themselves—all classic symptoms of manic depression."

Gregory added that nearly 100 percent of infants appear to suffer from the poor motor skills and impaired speech associated with Parkinson's disease.

Hat tip to LOTD

Leishmaniasis is the Answer to Challenge

The answer to yesterdays Medical Challenge was Leishmaniasis. This illness is found in tropical and subtropical areas and it is a parasite spread by bites of the sand fly. The skin sores erupt weeks to months after infection and the infection can also damage the spleen and liver. Cure rates are high with the proper antibiotics.

Lucky for us, we do not have this disease in the United States.

Electronic Health Record - Don't Hold Your Breath

The New England Journal of Medicine study that shows less than 2% of U.S. hospitals have a comprehensive electronic record is being discussed all over the news.

The benefits of going electronic, getting rid of wasteful paper, and providing all caregivers with the right information to care for patients has been proven time and time again. We can go to the moon. We can log onto Amazon and be recognized personally for our reading habits. We can have 6000 friends on Facebook. We can share our every thought on Twitter. So why are we stuck doing medicine like we did in 1950?

Here are some reasons why this is so damn hard.

Electronic health records, where physicians and caregivers can document, write notes, see information real time, do assessments and orders for patients, require millions of dollars in capital to develop and install. Seventy four percent of hospitals reported inadequate capital and 44% couldn't afford the maintenance costs.

Another barrier is the fact that electronic records systems are not interoperable. Imagine installing a $100 million dollar system that doesn't talk to anyone outside of the hospital. Patients are mobile. They go from physicians office to hospital to clinic to lab...and that is just within their own town. If the electronics cannot communicate, information is incomplete and possibly even dangerous.

One cannot underestimate the training and maintenance costs that accompany "going electronic". Think how you feel when your computer crashes or freezes or slows down. Hospitals need to build fire walls, redundancies, back-ups, plan for disasters. Systems need continual upgrades and all staff needs to have training and support. You can't shut down patient care while this is going on so you need to bring in extra staff for weeks while you are transitioning from paper to computers. Training and "help desk" expertise is an ongoing expense. Hospitals that do not have Information Technology specialists on staff will need to develop an entire department of hundreds of new experts.

Hospitals develop business plans for capital expenditures and look for a ROI. A third of hospitals surveyed did not believe they would recoup their investment in eHR.

These findings are sobering. We absolutely have to join the digital age and use technology and decision tools to improve quality, reduce error and become more efficient.

Irony

New Medical Challenge

Here is this weeks medical challenge from the New England Journal of Medicine. You be the doctor.

This patient is from Tunisia (North Africa on the Mediterranean) and this is what her ear looks like. What is the diagnosis? (These are all infectious diseases)

1. Leprosy (a mycobacterium)

2. Leishmaniasis (a protozoa from the bite of a sand fly)

3. Syphilis (a sexually transmitted spirochete bacterium)

4. TB (another mycobacterium)

5. Yaws (a spirochete bacterium transmitted by skin to skin contact)

Give your best shot and I'll post the answer tomorrow. This is how you get smarter.

First Study to Show Red Meat Linked to Early Death

We've known that there is a link between eating red meat and an increased risk of heart disease and colorectal cancer, but a new large study was published in the Archives of Internal Medicine that shows the changes of dying prematurely (mortality) was 30% higher in Americans that consumed just 4 ounces of red meat a day.

The study looked at almost 6,000 predominantly white volunteers ages 50-71. They controlled for other variables such as smoking, physical activity, vitamin use, age and they found that those who ate the most red meat and processed meat were more likely to die from any reason than those who consumed less.

Red meat was considered beef, pork, bacon, cold cuts, ham, liver and processed meats such as sausage, hot dogs and lunch meat. Processed meats were rated differently than non processed red meat in the study and high intake of processed meats caused higher deaths from cancer and cardiovascular disease than those who ate less nor no processed meats.

The people who ate white meat and fish were about 8% less likely to die during the study period. Poultry (chicken and turkey) contains more unsaturated fat and fish contains omega-3 fatty acids.

There are various ways red meat can be related to mortality. Cooked meat is the source of several carcinogens and the excess iron in red meat can also create oxidative damage in tissue. Meat is a major source of saturated fat which is related to C-V disease, breast and colorectal cancer. Also since we know grains, fruits and vegetables are linked to low cancer and C-V death rates, people who eat mainly meat probably eat less of those protective, healthy foods.

The take home message here is not new but this elegant study will probably bring out the big guns in the cattle and pig industry and livestock industrial farms. The take home message is eat mainly fruits, vegies, fish and poultry. Limit and reduce the red meat in your diet. Eat vegi burgers rather than hamburgers and try to never eat processed meat.

A Little Girl Needs Help

I have made international friends by blogging and I want to share an appeal from another blogger who has family in Armenia.

Gayane is a 13 year old girl who lives in a remote village of Davtashen. She has been diagnosed with a large ovarian tumor and she needs an immediate hysterectomy in the capital, Yerevan. The surgery will determine the tumor type (benign vs. cancer) and most tumors in young girls have low malignant potential and can be cured by removal. The tumor could be a teratoma, which is also curable with removal.

The surgery will cost $600-800 and Gayane's poor parents do not have the money. My blogging friend, Armen, will set up an account today in Gayane's name to pay for her surgery. I trust him and I am personally donating. I have a son Gayane's age and while I know there are millions of children that need help...this is the one that has reached out to me.

If you would like to contribute, please email: info@emaxhealth.com and Armen will promptly reply and answer any questions you may have.

PSA Tests for Men

I wish I would have written the post that Dr. Bob Wachter did on the new evidence about Prostate Specific Antigen (PSA) tests for men. Two new rigorous studies have been published in the New England Journal that address the value of PSA screening.

I can tell you that every man I treat asks for these tests and I have been pretty unsuccessful in influencing anyone to forgo the test or "watch and wait" if their levels were elevated. Yet I have seen elderly men decline rapidly after receiving prostate surgery or radiation that they never needed. Wachter quotes a Dartmouth Endocrinologist:

… In the final analysis, most of these one million extra cases of prostate cancer [diagnosed through PSA screening] represent nothing more than pseudodisease: disease that would never progress enough to cause symptoms—or flat-out would never progress at all… I should be clear that none of this should be interpreted as saying that PSA testing will never work. In fact, while many men may have been hurt by the ensuing treatment, a few others may have been helped. And it is possible that the PSA test can be modified such that it finds much less cancer and therefore makes much more sense. But right now we need to be clearer about the primary effect of the way it has been used so far: it has been making men sick.

You owe it to yourself (and your father or husband) to head over to Wachter's World and read what he has to say.

Swipe-It Medical Cards

Despite the fact that everything has changed in life with electronics, the way patients and insurance interact with providers remains back in the 1950s.

There is a effort being pushed for "swipe-it" ID cards that would be standardized no matter what health insurance or Medicare coverage a patient has. Here is how it would work:

The "Swipe-it" card would look like a credit card with an electronic stripe on the back. One swipe and the doctor or pharmacist or hospital would have your name, dependents, address and phone number. But even more, it would identify your exact insurance plan, your co-pay or deductible and what amount has been fulfilled for the year. It could link to a personal health record with your medications, allergies, medical conditions and other important information.

If I can go anywhere in the world and use (or be denied because I am over my limit) a credit card, this should be easy.

The savings would be profound. It is estimated that $1 billion is spent in wasted work by resubmitting rejected claims because the wrong information was transmitted. Current ID cards are not standard and can be on paper that dog ears or on colored plastic that does not clearly photocopy. Each insurer (United, Anthem Blue Cross, Cigna) can have hundreds of different plans and products, each with different coverage requirements, that are not reflected on the ID card.

We physicians have long thought that the confusion engendered by the Insurers is not a mistake but is a well oiled scheme for delaying and denying claims. It is usually up to the provider to track down and resubmit claims and this is one of the key reasons primary care has died. For small $$ office visit, the delays and denials of payment have killed the practice. It is the patient (and our Nation) who have ultimately suffered.

Swipe -it cards are about 20 years overdue. Perhaps health care reform will bring some common sense to this sick industry.

Smart People Think Faster

My mind is racing!

It turns out the smarter a person is, the faster their brain works. A study published in the Journal of Neuroscience, looked at intelligence (participants took an IQ test) and then used a technique called diffusion tensor imaging (DTI) that can measure the cells that carry nerve impulses from one part of the brain to another. The smarter the person, the more the pathways connecting brain cells lit up on the scan. Smarter people = faster nerve inpuse travel.

The lead researcher Dr. Paul Thompson, professor of neurology at UCLA School of Medicine said, "When you say someone is quick-thinking, it's genuinely true. The impulses are going faster and they are just more efficient at processing information, and then making a decision based on it."

By looking at twins, both identical (sharing the same genes) and non-identical (sharing only some genes), they were able to ascertain the genetic factors that play a role in brain speed. The genetic component of intelligence has a lot to do with the white matter tracks that connect different parts of the brain.

Thompson hopes his research can spot problems such as Alzheimer's disease, which slows down the brain. He also pointed out that although there is a genetic component to brain speed and intelligence, the more you "work" the brain, the faster it gets.

Excuse me while I go work on some crossword puzzles or learn a new language. My brain needs a work out.

Surprise About Prescription Drug Prices

A consumer report survey found that many people are getting surprised by prescription drug prices. In this time of cost consciousness, it is amazing how little people understand about how they can save money on medications.

About 52% of respondents did not have accurate information about generic drugs and these were people who spend more than $50 a month on prescriptions. Here's what the study found:

• 47% of people had reservations or misconceptions about generic drugs


• 46% said physicians never or sometimes recommended generics


• 28% cut costs by not filling prescriptions, skipping doses or cutting pills in half


• 4% talked with their doctor about the cost of a drug

The last one is the most important. Ask your doctor if the drug is available as a generic. The difference in outright cost or even the co-pay amount can be significant.

Many physicians get used to writing a certain "brand" and don't think to write for a cheaper medication that would work just as well. So protect your pocketbook and get informed and ASK!

Religious People Seek More Treatment

The New York Times reported on a new study that shows religious folks want more end of life, aggressive treatment when they have a terminal illness (cancer) than non church goers. We know that 80% of health care costs are spent in the last 6 weeks of life and that so many aggressive treatments are done when a person should be comfortably exiting this life. Aggressive end of life care can lead to a more painful and emotionally draining experience for family members too.

Hmmm. Let me think about this. Religious people believe in heaven (and hell) and say they trust in "God's will", but they opt for mechanical ventilators and don't prepare living wills, according the the study that will be published in JAMA. What is it about religion that would make a person want to "hang around" in an ICU on a ventilator, in this old, sick body, when heaven and the angels are beckoning? Shouldn't belief in an afterlife bring more peace and comfort about leaving the mortal body behind?

Apparently this study was done with Christian denominations so we don't know if Jews, Hindus, Muslims or Hari Krishnas also want heroic (mostly wasteful) end of life care.

Just reporting it, folks.

No Wonder Medicare is Broke

I wouldn't have believed this if I hadn't seen it with my very own eyes. A doctor I practice with send a Medicare patient (that means over age 65 with their health care covered by you and me paying taxes!!!) to a medical supply store to get a carpal tunnel splint. Even though we carry these splints in the office, we don't supply them to Medicare patients because Medicare will never reimburse us the $22 fee for the splint. So we have to send the patient to an ortho supplier, which is a hassle for the patient but what choice do we have?

This splint doesn't require fitting. It comes in small, medium and large and just "velcros" together. The patient got a copy of the bill to Medicare....drumroll...$900.00. Yes, $900.00 for a simple wrist splint.

Medicare will not pay the entire amount but the supplier knows they will get a HUGE portion of that charge. What if they only get 1/2? Folks, you can't make this stuff up. The waste and crazy payment systems are killing us. They bill it BECAUSE THEY CAN!

No wonder our health care system is broken.

True Leadership

Paul Levy, the transparent blogging CEO at Beth Israel Deaconess Medical Center in Boston, is facing what many hospitals are going through: reduced Medicaid and insurance payments, declining census due to the economy and predicted operating losses of $20 million. His financial team is looking at hard choices that include massive layoffs of valued employees.

So how does he approach this awful situation? He sent letters to all the employees and held town hall meetings at several locations where he layed out the problems clearly and openly. He made suggestions for avoiding layoffs and asked for input. He quickly developed an an electronic suggestion box and website where employees could weigh in and comment on the plans. He asked for help to find ways to minimize or even avoid laying off workers that are working 2 jobs to make ends meet.

He announced : "The senior managers of the hospital have recognized their personal responsibility to help with this problem. The senior vice presidents, vice presidents, and chief operating officer have been asked to take voluntary 5% pay reductions, and I have eliminated all of their bonuses for 2009, a total potential pay reduction of 15% to 25%. I am personally taking a 10% salary reduction and will forgo my bonus opportunity for this year, a total potential pay reduction of 30%."

The response has been nothing short of amazing. Hundreds of employees have entered the chat rooms and agree to voluntarily give up vacation time, bonuses, pay, weekend differentials to help keep their fellow employees working. None of the comments are "edited" by the marketing department (a feat I find amazing!) and open communication is encouraged.

The publicity from this simple act of LEADERSHIP has inspired other business owners to look at the economy and alter how they think of employees. Paul Levy posted this letter he received from another owner on his blog Running a Hospital:


JUST WANTED TO LET YOU KNOW SIR AS A BUSINESS OWNER MYSELF HERE IN FT.LAUDERDALE, FLORIDA. PLEASE LET MR.LEVY KNOW THAT MY HEART AND MY BLESSINGS GO OUT TO HIM AND I THINK THAT HE IS ON THE RIGHT TRACK. I ALSO MAY NEED TO LAY OFF SOME OF MY STAFF BUT AFTER READING HIS STORY I SHALL RECONSIDER. AFTER I READ THIS STORY I HAD A MEETING WITH MY STAFF AND THEY ALL CAME TOGETHER AND ARE ON THE SAME OPINION AS HIS STAFF AND I THINK THAT WE WILL TRY DIFFERENT MEASURES TO TRY TO KEEP ALL OF OUR PEOPLE WORKING. I REALLY THINK THAT THIS NEEDS TO BE ON THE NEWS WORLDWIDE. THE MAN TO ME IS A HERO. THANK YOU FOR YOUR REPORT SIR. IT MADE MY LIFE AND MY EMPLOYEES LIFE A WHOLE LOT HAPPIER TODAY. THANK YOU AGAIN.

VICE PRESIDENT OF EXPERT DIESEL
BOB RUIZ

Latvias Strange Restaurant

Latvia, that small little Baltic republic, is bordered by Estonia to the North and Lithuania to the South. It also abuts Belarus and Russia.

EverythingHealth has had visits from Latvia (welcome, Latvians!) and I always find it so rewarding to think of how we are interconnected via the internet.

The Latvians must have quite a bizarre sense of humor. A group of local doctors and hospitals own a restaurant that serves hearty Latvian dishes topped with realistic-looking body parts such as fingers, noses and tongues. They serve the food on gurneys and operating tables and the cutlery is tweezers and scalpels.

The trendy cocktail bar is all the rage, with bartenders in white lab coats, drinks served in beakers and waitresses in skimpy nurse outfits.

Latvia's answer to Hooters or Bubba Gumps, I guess.

(Hat tip to KM for this one.)

Big Pharma and Doctors

It is insane that we let problems get out of hand and then OVER-REACT by legislating ridiculous rules that hurt industry and growth. I am speaking about the new federal law that Congress is discussing that says medical device and pharmaceutical companies cannot give pens or lunch or sticky note pads to physicians and they have to report any consulting or speaking payments of over $50.00. Massachusetts has already adopted these bans and there is a patchwork of other states with their own laws.

I have written before about the egregious behavior of physicians and research institutes being far to cozy with big Pharma and Medical Device manufacturers. Orthopedic surgeons have received hundreds of thousands of dollars (each) in "consulting fees" for using certain expensive artificial joints. The American Academy of Psychiatry is cleaning house after being exposed by Senator Grassley's investigation into the unethical behavior and unregulated greed of academic psychiatrists promoting questionable drugs for kids. I've also written on big Pharma price gouging and how it should be stopped.

So make no mistake...I am against corruption, lack of medical ethics and greed. We are here for the good of our patients...period.

That said, the pendulum is swinging too far. Innovation is the hallmark of advancing medicine. There is a natural affinity for research physicians and big Pharma and it is usually a healthy relationship. Clinicians are dependent upon continuing education throughout their careers (or we would still be using lobotomy or arsenic to treat infection) and much good comes from programs that advance our knowledge. Those programs need credible speakers and those speakers need to be well compensated for their expertise.

I have been a pharmaceutical speaker and I was well compensated. My talks were balanced with evidence based literature, treatment options and outcomes. I was sponsored by Lilly, Wyeth and Pfizer at different times. If I had to fill out reams of paperwork or be offered $50, they would not have secured my service (or anyone else that could hold the attention of a crowd)

The legislatures that are adopting these laws need to look in the mirror and clean up their own house first.

Ecstasy for Treating Post Traumatic Stress Disorder

Ecstasy (MDMA) didn't start out as a "rave" party drug. It was first synthesized in 1912 and rediscovered in the mid 1970s by the psychotherapy community as a treatment to be used in psychoanalysis. Over 4000 psychologists were introduced to MDMA and they found it helped withdrawn patients open up and develop truthful relationships with the analyst. They found that it alleviated fear, guilt and remorse and sped up the psychoanalytic process.

In 1984 the use spread to college students and by 1987 it's use as a party drug spread around the world. In 1985 the FDA banned the use of Ecstasy as a danger to the public. Since that time it went completely underground, however it's use has continued to soar.

In 1993, limited trials were approved by the FDA to test the effects of Ecstasy in human volunteers. The Multidisciplinary Association for Psychedelic Studies is sponsoring trials to determine potential risks and benefits of using the drug as part of the psychotherapy for treating post-traumatic stress disorder. Nearly 20% of all returning soldiers from Iraq and Afghanistan suffer from PTSD. Early reports show MDMA can truncate years of therapy into two or three hours.

The Psychiatrists say it will not be used like antidepressants but only under supervision in controlled environments to enhance the psycho therapeutic interchange. Using MDMA improves the tolerance for recall and reliving painful memories without anxiety. The veterans are able to deal with their memories with a feeling of being in the present and feeling safe.

With these promising early results, the use of Ecstasy to treat PTSD is likely to continue.

eating disorder ad

Anorexia affects mainly women (95%) and there is no single known cause for this serious condition. People who are anorexic have a distorted body image with obsessive fear of gaining weight. There are some genetic tendencies toward eating disorders (as noted in twin studies) as well as behavioral, emotional and cultural causes. It is a serious medical condition that requires treatment and sometimes hospitalization.

YouBars/YouShakes Winner

Congratulations to Tim Pope, the hardworking baggage handler who usually eats junk, for being the winner of the YouBars contest. Thanks to all who entered. There were some very compelling and heart rending stories (like "I'm hungry") and everyone can win by checking out the YouBars website.

We will have more healthy contests coming soon for the chance to win free stuff so check back daily to EverythingHealth.

Skin Patches and MRI

The FDA has issued an alert to warn patients and imaging professionals that certain medicated skin patches can overheat during an MRI scan and cause a skin burn.

Apparently some patches contain aluminum and other metals in the backing that sticks to the skin. With more and more medications being administered through the "patch" the best advice is for patients to remove the patch prior to the MRI scan and replace a new one after.

This does not apply to CT scans or ultrasounds as they are a different technology.

Stem Cell Research and Obama

I wrote this post during the Obama Inaguration. Just repeating it since it is now reality!

There is speculation on the Hill about whether President Obama will immediately reverse the ban on stem cell research by executive order, or wait until Congress submits a bill to him that he would sign. I think it is about 50/50.

Either way, these are significant steps in the right direction after 8 years of "anti-science" and suppression of expert research under the Bush administration. Former Surgeon-General under Bush, Dr. Richard Carmona complained he was muzzled in attempts to speak out on stem cell science and other issues.

The fact that Obama is likely to be lifting the restrictions on US federal funding of human embryonic stem cell research speaks volumes about how he will govern.

Stem cell research from public funding will potentially ensure open access to research results and allow easier transition from research to development of new therapies and cures for patients with a wide range of illnesses.

In 2007, Senator Obama co-sponsored the Stem Cell Research Enhancement Act and said the study of stem cells held enormous promise for the treatment of debilitating and life-threatening diseases, like Alzheimer's, diabetes and spinal cord injury. "Instead of creating roadblocks, we must all work together to expand federal funding of stem cell research and continue moving forward in our fight against disease by advancing our knowledge through science and medicine", then Senator Obama said.

It will be interesting to see what first Executive decisions, President Obama will make after he recovers from the partying night of the inauguration. He has pledged to start work on Wednesday and get a stimulus recovery bill passed ASAP. Many are hoping he makes good on reversing the Embryonic Stem Cell ban also.

TV Does Not Improve IQ in Toddlers

A new study in Pediatrics shows that children under the age of two who watch TV do not have a boost in their IQ. There had been claims that certain shows helped children's brain development and cognitive skills but this study of 872 toddlers showed TV viewing had no effect one way or another.

Researchers evaluated the children's language and visual motor skills using the Peabody Picture Vocabulary Test III, which is associated with IQ. Preliminary results showed the kids who watched more TV had poorer scores on these tests but those effects did not hold up when they controlled for other factors such as mother's age, education, household income and marital status.

Other studies have shown that watching TV does more harm than good for babies.

The American Academy of Pediatrics recommends no television viewing for children under age 2. The Harvard researchers found that most babies born in the U.S. watch between one to two hours of TV a day. (Perhaps they were watching Oprah with their moms. I hope it wasn't Jerry Springer).

Only Two More Days For the Contest

Scroll down for the YouBars contest. Just enter your comment on why making custom YouBars and YouShakes will be good for you and you may win!

Hudson River Plane Landing (US Airways 1549) Animation with Audio

The training and improved patient safety we want for Healthcare is often compared to the aerospace industry. A pilot can fly a route thousands of times and the surgeon can do the same operation thousands of times but when something goes wrong you need to fall back on checklists, protocols, standards in communication and calm thinking. This landing is SICK (in the good way my 14 year old says sick). The pilot's calm, crisp, clear communication gives me chills. I want surgeons to have the same training and protocols for surgery outcomes.

EverythingHealth Contest

YouBars is a really cool idea where you can personalize your own nutrition bars and shakes. Instead of buying mass produced bars, you can custom make your own bars with less sugar, no milk (for those lactose intolerant folks) or with more carbs if you are a runner. By building in your own flavors, fruit, protein ( soy, egg white, rice or milk) and your own sweeteners (organic sugar cane juice, agave or splenda) you can get the exact nutrition that suits your lifestyle.

Here is your chance to win (free, absolutely free) a pack of the most popular YouBars and You Shakes so you can see what it is all about. I tried them and they are really good. I like the shakes blended with fruit to make sure I start my day with some protein. Note: they don't take the place of my morning Latte.

So make a comment and let me know why you want to try YouBars. Be creative or just whine and say "I want to win something to cheer me up since my 401K has gone to pay bonuses to the GM presidents ".

We will pick a winner on Tuesday so let us know why it should be you.

Fertility Drugs Do Not Cause Ovarian Cancer

With so many women around the world taking strong hormones and fertility drugs to aid in pregnancy, there has been a fear that these drugs would be associated with increased risk of ovarian cancer. We know that infertility and no child bearing increases the risk of ovarian cancer.

Now a new large study conducted in Denmark and published in the British Medical Journal shows there is no increase in ovarian cancer for women who used fertility drugs.

This study looked at 54,362 Danish women from 1963 through 1998. They followed them for 16 years. The women used clomiphene, chorionic gonadotrophins and gonadotrophin releasing hromone...all strong stimulants of ovulation.

No increase in cancer was found in women who used these drugs individually or in 5 common combinations compared to the control group who used no drugs.

This study is reassuring to women who use fertility drugs to get pregnant.

American Culture

It's time to send David back home to Italy.

(Hat tip to Happy Hospitalist)

New Vitamin Research on B12 and Vitamin D

I have shown scientific data numerous times on EverythingHealth that shows our obsession with vitamins and supplements taken daily as cancer or cardiovascular disease prevention is money down the drain.

There are certain conditions, however, where good data shows us certain vitamins play a beneficial role. Here are two new studies:

Recurrent aphthous stomatitis (also known as mouth canker sores) is a painful and unexplained condition. Some patients have outbreak after outbreak and we use adhesive pastes, antiseptics and steroids to deal with the pain. A new study shows vitamin B12 (1000mcg) taken daily for 6 months, reduced the pain, the number of ulcers and the duration of outbreaks. By 6 months the vitamin taking group was free of outbreaks. The scientists found that the initial blood level of Vitamin B12 didn't matter so there is no need to check that test.

Score one for Vitamin B12 and canker sores.

The second study showed another benefit for taking Vitamin D if blood levels are low. Patients who had lower levels of serum Vitamin D were more likely to develop upper respiratory tract infections, even after the scientists controlled for smoking, body mass index, asthma and chronic obstructive pulmonary disease. Low Vitamin D levels have also been associated with cancer, cardiovascular disease, Parkinson's and bone disorders.

I check Vitamin D levels in all patients and advise supplements if the levels are low.

I am not against vitamins. But I am scientifically driven and I'm against "wishful thinking" that handfuls of vitamins can protect us from diseases when there is no science to back up those claims. Put your money into organic foods instead.

Grand Rounds is Up

The best of the medical blogosphere for this week can be found at Health business blog. Good reading and interesting articles.

The T-Mobile Dance

Here is a treat to start your week off. The coordination is amazing.

Cocaine Nose

A picture is worth a thousand words. This 50 year old man had used cocaine for 20 years. Cocaine causes vasoconstriction and in fact, it is used as a local anesthetic medically when there is a need to do a procedure and stop bleeding. This same vasoconstrictive property can cause skin breakdown and erosion of the nasal septum.

photo credit: Consultant